Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices

ABSTRACT

A method implemented by a surgical instrument is disclosed. The surgical instrument includes first and second jaws and a flexible circuit including multiple sensors to optimize performance of a radio frequency (RF) device. The flexible circuit includes at least one therapeutic electrode couplable to a source of RF energy, at least two sensing electrodes, and at least one insulative layer. The insulative layer is positioned between the at least one therapeutic electrode and the at least two sensing electrodes. The method includes contacting tissue positioned between the first and second jaws of the surgical instrument with the at least one therapeutic electrode and at the least two sensing electrodes; sensing signals from the at least two sensing electrodes; and controlling RF energy delivered to the at least one therapeutic electrode based on the sensed signals.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a continuation application claiming priority35 U.S.C. § 120 to U.S. patent application Ser. No. 17/825,754, titledMETHOD OF USING REINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TOOPTIMIZE PERFORMANCE OF RADIO FREQUENCY DEVICES, filed on May 26, 2022,which issued on Oct. 10, 2023 as U.S. Pat. No. 11,779,337 and which is acontinuation application claiming priority under 35 U.S.C. § 120 to U.S.patent application Ser. No. 16/209,427, titled METHOD OF USINGREINFORCED FLEXIBLE CIRCUITS WITH MULTIPLE SENSORS TO OPTIMIZEPERFORMANCE OF RADIO FREQUENCY DEVICES, filed on Dec. 4, 2018, whichissued on Jul. 19, 2022 as U.S. Pat. No. 11,389,165 and which claimspriority under 35 U.S.C. § 119(e) to each of the following: U.S.Provisional Patent Application No. 62/773,778, titled METHOD FORADAPTIVE CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION,filed on Nov. 30, 2018; U.S. Provisional Patent Application No.62/773,728, titled METHOD FOR SITUATIONAL AWARENESS FOR SURGICAL NETWORKOR SURGICAL NETWORK CONNECTED DEVICE CAPABLE OF ADJUSTING FUNCTION BASEDON A SENSED SITUATION OR USAGE, filed on Nov. 30, 2018; U.S. ProvisionalPatent Application No. 62/773,741, titled METHOD FOR FACILITY DATACOLLECTION AND INTERPRETATION, filed on Nov. 30, 2018; U.S. ProvisionalPatent Application No. 62/773,742, titled METHOD FOR CIRCULAR STAPLERCONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL AWARENESS, filed onNov. 30, 2018; U.S. Provisional Patent Application No. 62/750,529,titled METHOD FOR OPERATING A POWERED ARTICULATING MULTI-CLIP APPLIER,filed on Oct. 25, 2018; U.S. Provisional Patent Application No.62/750,539, titled SURGICAL CLIP APPLIER, filed on Oct. 25, 2018; U.S.Provisional Patent Application No. 62/750,555, titled SURGICAL CLIPAPPLIER, filed on Oct. 25, 2018; U.S. Provisional Patent Application No.62/729,183, titled CONTROL FOR A SURGICAL NETWORK OR SURGICAL NETWORKCONNECTED DEVICE THAT ADJUSTS ITS FUNCTION BASED ON A SENSED SITUATIONOR USAGE, filed on Sep. 10, 2018; U.S. Provisional Patent ApplicationNo. 62/729,177, titled AUTOMATED DATA SCALING, ALIGNMENT, AND ORGANIZINGBASED ON PREDEFINED PARAMETERS WITHIN A SURGICAL NETWORK BEFORETRANSMISSION, filed on Sep. 10, 2018; U.S. Provisional PatentApplication No. 62/729,176, titled INDIRECT COMMAND AND CONTROL OF AFIRST OPERATING ROOM SYSTEM THROUGH THE USE OF A SECOND OPERATING ROOMSYSTEM WITHIN A STERILE FIELD WHERE THE SECOND OPERATING ROOM SYSTEM HASPRIMARY AND SECONDARY OPERATING MODES, filed on Sep. 10, 2018; U.S.Provisional Patent Application No. 62/729,185, titled POWERED STAPLINGDEVICE THAT IS CAPABLE OF ADJUSTING FORCE, ADVANCEMENT SPEED, ANDOVERALL STROKE OF CUTTING MEMBER OF THE DEVICE BASED ON SENSED PARAMETEROF FIRING OR CLAMPING, filed on Sep. 10, 2018; U.S. Provisional PatentApplication No. 62/729,184, titled POWERED SURGICAL TOOL WITH APREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR CONTROLLING AT LEAST ONE ENDEFFECTOR PARAMETER AND A MEANS FOR LIMITING THE ADJUSTMENT, filed onSep. 10, 2018; U.S. Provisional Patent Application No. 62/729,182,titled SENSING THE PATIENT POSITION AND CONTACT UTILIZING THE MONO-POLARRETURN PAD ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB, filedon Sep. 10, 2018; U.S. Provisional Patent Application No. 62/729,191,titled SURGICAL NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OFPROCEDURE VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THEOPTIMAL SOLUTION, filed on Sep. 10, 2018; U.S. Provisional PatentApplication No. 62/729,195, titled ULTRASONIC ENERGY DEVICE WHICH VARIESPRESSURE APPLIED BY CLAMP ARM TO PROVIDE THRESHOLD CONTROL PRESSURE AT ACUT PROGRESSION LOCATION, filed on Sep. 10, 2018; U.S. ProvisionalPatent Application No. 62/729,186, titled WIRELESS PAIRING OF A SURGICALDEVICE WITH ANOTHER DEVICE WITHIN A STERILE SURGICAL FIELD BASED ON THEUSAGE AND SITUATIONAL AWARENESS OF DEVICES, filed on Sep. 10, 2018; U.S.Provisional Patent Application No. 62/721,995, titled CONTROLLING ANULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION, filed onAug. 23, 2018; U.S. Provisional Patent Application No. 62/721,998,titled SITUATIONAL AWARENESS OF ELECTROSURGICAL SYSTEMS, filed on Aug.23, 2018; U.S. Provisional Patent Application No. 62/721,999, titledINTERRUPTION OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING, filed onAug. 23, 2018; U.S. Provisional Patent Application No. 62/721,994,titled BIPOLAR COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSUREBASED ON ENERGY MODALITY, filed on Aug. 23, 2018; U.S. ProvisionalPatent Application No. 62/721,996, titled RADIO FREQUENCY ENERGY DEVICEFOR DELIVERING COMBINED ELECTRICAL SIGNALS, filed on Aug. 23, 2018; U.S.Provisional Patent Application No. 62/692,747, titled SMART ACTIVATIONOF AN ENERGY DEVICE BY ANOTHER DEVICE, filed on Jun. 30, 2018; U.S.Provisional Patent Application No. 62/692,748, titled SMART ENERGYARCHITECTURE, filed on Jun. 30, 2018; U.S. Provisional PatentApplication No. 62/692,768, titled SMART ENERGY DEVICES, filed on Jun.30, 2018; U.S. Provisional Patent Application No. 62/691,228, titledMETHOD OF USING REINFORCED FLEX CIRCUITS WITH MULTIPLE SENSORS WITHELECTROSURGICAL DEVICES, filed on Jun. 28, 2018; U.S. Provisional PatentApplication No. 62/691,227, titled CONTROLLING A SURGICAL INSTRUMENTACCORDING TO SENSED CLOSURE PARAMETERS, filed on Jun. 28, 2018; U.S.Provisional Patent Application No. 62/691,230, titled SURGICALINSTRUMENT HAVING A FLEXIBLE ELECTRODE, filed on Jun. 28, 2018; U.S.Provisional Patent Application No. 62/691,219, titled SURGICALEVACUATION SENSING AND MOTOR CONTROL, filed on Jun. 28, 2018; U.S.Provisional Patent Application No. 62/691,257, titled COMMUNICATION OFSMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR CLOUD IN SMOKE EVACUATIONMODULE FOR INTERACTIVE SURGICAL PLATFORM, filed on Jun. 28, 2018; U.S.Provisional Patent Application No. 62/691,262, titled SURGICALEVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION BETWEENA FILTER AND A SMOKE EVACUATION DEVICE, filed on Jun. 28, 2018; U.S.Provisional Patent Application No. 62/691,251, titled DUAL IN-SERIESLARGE AND SMALL DROPLET FILTERS, filed on Jun. 28, 2018; U.S.Provisional Patent Application No. 62/665,129, titled SURGICAL SUTURINGSYSTEMS, filed on May 1, 2018; U.S. Provisional Patent Application No.62/665,139, titled SURGICAL INSTRUMENTS COMPRISING CONTROL SYSTEMS,filed on May 1, 2018; U.S. Provisional Patent Application No.62/665,177, titled SURGICAL INSTRUMENTS COMPRISING HANDLE ARRANGEMENTS,filed on May 1, 2018; U.S. Provisional Patent Application No.62/665,128, titled MODULAR SURGICAL INSTRUMENTS, filed on May 1, 2018;U.S. Provisional Patent Application No. 62/665,192, titled SURGICALDISSECTORS, filed on May 1, 2018; U.S. Provisional Patent ApplicationNo. 62/665,134, titled SURGICAL CLIP APPLIER, filed on May 1, 2018; U.S.Provisional Patent Application No. 62/659,900, titled METHOD OF HUBCOMMUNICATION, filed on Apr. 19, 2018; U.S. Provisional PatentApplication No. 62/650,898, filed on Mar. 30, 2018, titled CAPACITIVECOUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS, U.S. ProvisionalPatent Application No. 62/650,887, titled SURGICAL SYSTEMS WITHOPTIMIZED SENSING CAPABILITIES, filed on Mar. 30, 2018; U.S. ProvisionalPatent Application No. 62/650,882, titled SMOKE EVACUATION MODULE FORINTERACTIVE SURGICAL PLATFORM, filed on Mar. 30, 2018; U.S. ProvisionalPatent Application No. 62/650,877, titled SURGICAL SMOKE EVACUATIONSENSING AND CONTROLS, filed on Mar. 30, 2018; U.S. Provisional PatentApplication No. 62/649,302, titled INTERACTIVE SURGICAL SYSTEMS WITHENCRYPTED COMMUNICATION CAPABILITIES, filed on Mar. 28, 2018; U.S.Provisional Patent Application No. 62/649,294, titled DATA STRIPPINGMETHOD TO INTERROGATE PATIENT RECORDS AND CREATE ANONYMIZED RECORD,filed on Mar. 28, 2018; U.S. Provisional Patent Application No.62/649,300, titled SURGICAL HUB SITUATIONAL AWARENESS, filed on Mar. 28,2018; U.S. Provisional Patent Application No. 62/649,309, titledSURGICAL HUB SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATINGTHEATER, filed on Mar. 28, 2018; U.S. Provisional Patent Application No.62/649,310, titled COMPUTER IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS,filed on Mar. 28, 2018; U.S. Provisional Patent Application No.62/649,291, titled USE OF LASER LIGHT AND RED-GREEN-BLUE COLORATION TODETERMINE PROPERTIES OF BACK SCATTERED LIGHT, filed on Mar. 28, 2018;U.S. Provisional Patent Application No. 62/649,296, titled ADAPTIVECONTROL PROGRAM UPDATES FOR SURGICAL DEVICES, filed on Mar. 28, 2018;U.S. Provisional Patent Application No. 62/649,333, titled CLOUD-BASEDMEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A USER, filedon Mar. 28, 2018; 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BACKGROUND

This application discloses an invention that is related, generally andin various aspects, to surgical systems, surgical instruments, andflexible circuits.

Surgical instruments include components that are required to move invarious directions and/or are subjected to different forces. Forexample, shafts rotate, articulate, and experience different tensions;jaws pivot open and closed and experience unwanted flexing ordeformation; and cutting members move axially in distal and proximaldirections and experience different resistive forces.

Surgical instruments may also include additional components such aselectrodes, sensing devices, processing circuits, motors, and wiringand/or wiring traces, some of which can be located within variousportions of a surgical instrument. For example, a sensing device and/ora processing circuit can be located within an end effector of thesurgical instrument, within a shaft assembly of the surgical instrumentand/or within a handle assembly of the surgical instrument. Suchadditional components can form electrical circuits of the surgicalinstrument, and portions of such electrical circuits can also berequired to move in various directions and/or be subjected to differentforces.

In many instances, the jaw electrodes of various surgical instrumentsare rigid, are utilized as therapeutic electrodes that applyelectrosurgical energy to tissue positioned between the jaws,collectively take up close to an entire width of the jaws, and canexperience flexing or deformation as the jaws open and close. Forsurgical instruments that include a knife that traverses a slot definedby the jaws, a first electrode can be positioned to a first side (e.g.,a right hand side) of the slot and a second electrode can be positionedto a second side (e.g., a left hand side) of the slot.

Due to their rigid nature, the unwanted flexing or deformation of theelectrodes can lead to premature failure. Also, by collectively takingup close to an entire width of the jaws, the electrodes have arelatively large surface area that is in contact with tissue positionedbetween the jaws. When the electrodes deliver radio-frequency (RF)energy to the tissue, the large surface area of the electrodes cancontribute to unwanted tissue sticking. Additionally, the large surfacearea of the electrodes leaves little room for sensing and/or measurementdevices to have contact with tissue positioned between the jaws.

With traditional electrical circuits in surgical instruments, portionsof the electrical circuits which are required to move in variousdirections and/or be subjected to different forces tend to pull out orseparate from their connection to the surgical instrument and/or fail ata rate which is higher than desired.

SUMMARY

In one aspect the present disclosure provides a method implemented by asurgical instrument. The surgical instrument comprising first and secondjaws and a flexible circuit comprising multiple sensors to optimizeperformance of a radio frequency (RF) device. The flexible circuitcomprising at least one therapeutic electrode couplable to a source ofRF energy, at least two sensing electrodes, and at least one insulativelayer. The insulative layer is positioned between the at least onetherapeutic electrode and the at least two sensing electrodes. Themethod comprising: contacting tissue positioned between the first andsecond jaws of the surgical instrument with the at least one therapeuticelectrode and at the least two sensing electrodes; sensing signals fromthe at the least two sensing electrodes; and controlling RF energydelivered to the at least one therapeutic electrode based on the sensedsignals.

In another aspect the present disclosure provides a method implementedby a surgical instrument comprising an end effector, a marking assembly,and a control circuit. The end effector comprising a first jaw, a secondjaw movable relative to the first jaw to grasp tissue therebetween, aplurality of sensors, and a tissue-treatment mechanism configured toapply a tissue treatment to tissue grasped between the first jaw and thesecond jaw. Tthe method comprising: receiving, by the control circuit, aplurality of sensor signals from the plurality of sensors indicative ofapplication of a tissue treatment to the tissue; controlling, by thecontrol circuit, radiofrequency (RF) energy to the end effector to treatthe tissue; applying, by the marking assembly, a distinct marking to thetissue unique to the tissue treatment application, wherein the distinctmarking distinguishes the tissue treatment application from other tissuetreatment applications.

In another aspect the present disclosure provides a method implementedby a surgical instrument. The surgical instrument comprising a controlcircuit, a multi-level flexible electrode. The multi-level flexibleelectrode comprises first, second, and third insulative layers. Themulti-level flexible electrode further comprises at least onetherapeutic electrode and at least two sensing electrodes. Thetherapeutic electrode is positioned between the first and secondinsulative layers. The therapeutic electrode is couplable to a source ofradiofrequency (RF) energy. The sensing electrode is positioned betweenthe second and third insulative layers. The method comprising:contacting tissue by the at least one therapeutic electrode and the atleast two sensing electrodes; delivering RF energy to the contactedtissue by the at least one therapeutic electrode; sensing, by the atleast two sensing electrodes, a parameter associated with tissuepositioned between first and second jaws of the surgical instrument; andcontrolling, by the control circuit, RF energy delivered to the at leastone therapeutic electrode based on the sensed parameter.

BRIEF DESCRIPTION

The features of various aspects are set forth with particularity in theappended claims. The various aspects, however, both as to organizationand methods of operation, together with further objects and advantagesthereof, may best be understood by reference to the followingdescription, taken in conjunction with the accompanying drawings asfollows.

FIG. 1 is a block diagram of a computer-implemented interactive surgicalsystem, in accordance with at least one aspect of the presentdisclosure.

FIG. 2 is a surgical system being used to perform a surgical procedurein an operating room, in accordance with at least one aspect of thepresent disclosure.

FIG. 3 is a surgical hub paired with a visualization system, a roboticsystem, and an intelligent instrument, in accordance with at least oneaspect of the present disclosure.

FIG. 4 is a partial perspective view of a surgical hub enclosure and ofa combo generator module slidably receivable in a drawer of the surgicalhub enclosure, in accordance with at least one aspect of the presentdisclosure.

FIG. 5 is a perspective view of a combo generator module with bipolar,ultrasonic, and monopolar contacts and a smoke evacuation component, inaccordance with at least one aspect of the present disclosure.

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing configured to receivea plurality of modules, in accordance with at least one aspect of thepresent disclosure.

FIG. 7 illustrates a vertical modular housing configured to receive aplurality of modules, in accordance with at least one aspect of thepresent disclosure.

FIG. 8 illustrates a surgical data network comprising a modularcommunication hub configured to connect modular devices located in oneor more operating theaters of a healthcare facility, or any room in ahealthcare facility specially equipped for surgical operations, to thecloud, in accordance with at least one aspect of the present disclosure.

FIG. 9 illustrates a computer-implemented interactive surgical system,in accordance with at least one aspect of the present disclosure.

FIG. 10 illustrates a surgical hub comprising a plurality of modulescoupled to the modular control tower, in accordance with at least oneaspect of the present disclosure.

FIG. 11 illustrates one aspect of a Universal Serial Bus (USB) networkhub device, in accordance with at least one aspect of the presentdisclosure.

FIG. 12 illustrates a logic diagram of a control system of a surgicalinstrument or tool, in accordance with at least one aspect of thepresent disclosure.

FIG. 13 illustrates a control circuit configured to control aspects ofthe surgical instrument or tool, in accordance with at least one aspectof the present disclosure.

FIG. 14 illustrates a combinational logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 15 illustrates a sequential logic circuit configured to controlaspects of the surgical instrument or tool, in accordance with at leastone aspect of the present disclosure.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors that can be activated to perform various functions, inaccordance with at least one aspect of the present disclosure.

FIG. 17 is a schematic diagram of a robotic surgical instrumentconfigured to operate a surgical tool described herein, in accordancewith at least one aspect of the present disclosure.

FIG. 18 illustrates a block diagram of a surgical instrument programmedto control the distal translation of a displacement member, inaccordance with at least one aspect of the present disclosure.

FIG. 19 is a schematic diagram of a surgical instrument configured tocontrol various functions, in accordance with at least one aspect of thepresent disclosure.

FIG. 20 is a simplified block diagram of a generator configured toprovide inductorless tuning, among other benefits, in accordance with atleast one aspect of the present disclosure.

FIG. 21 illustrates an example of a generator, which is one form of thegenerator of FIG. 20 , in accordance with at least one aspect of thepresent disclosure.

FIG. 22 illustrates a surgical instrument, in accordance with at leastone aspect of the present disclosure.

FIG. 23 illustrates a shaft assembly of the surgical instrument of FIG.22 , in accordance with at least one other aspect of the presentdisclosure.

FIG. 24 illustrates a flexible circuit of the surgical instrument ofFIG. 22 , in accordance with at least one aspect of the presentdisclosure.

FIG. 25 illustrates a channel retainer of the surgical instrument ofFIG. 22 , in accordance with at least one aspect of the presentdisclosure.

FIG. 26 illustrates a cross-section of the flexible circuit along theline A-A of FIG. 24 , in accordance with at least one aspect of thepresent disclosure.

FIG. 27 illustrates a cross-section of the flexible circuit along theline B-B of FIG. 24 , in accordance with at least one aspect of thepresent disclosure.

FIG. 28 illustrates an exploded view of a flexible electrode of thesurgical instrument of FIG. 22 , in accordance with at least one aspectof the present disclosure.

FIGS. 29 and 30 illustrate top views of a flexible electrode of thesurgical instrument of FIG. 22 , in accordance with at least one aspectof the present disclosure.

FIG. 31 illustrates an exploded view of a flexible electrode of thesurgical instrument of FIG. 22 , in accordance with at least one otheraspect of the present disclosure.

FIG. 32 illustrates an end view of a flexible electrode of the surgicalinstrument of FIG. 22 , in accordance with at least one other aspect ofthe present disclosure.

FIG. 33 illustrates a top perspective view of a flexible electrode ofthe surgical instrument of FIG. 22 , in accordance with at least oneother aspect of the present disclosure.

FIG. 34 is a perspective view of a surgical instrument that has aninterchangeable shaft assembly operably coupled thereto, in accordancewith at least one aspect of the present disclosure.

FIG. 35 is an exploded assembly view of a portion of the surgicalinstrument of FIG. 34 , in accordance with at least one aspect of thepresent disclosure.

FIG. 36 is an exploded assembly view of portions of the interchangeableshaft assembly, in accordance with at least one aspect of the presentdisclosure.

FIG. 37 is an exploded view of an end effector of the surgicalinstrument of FIG. 34 , in accordance with at least one aspect of thepresent disclosure.

FIG. 38A is a block diagram of a control circuit of the surgicalinstrument of FIG. 34 spanning two drawing sheets, in accordance with atleast one aspect of the present disclosure.

FIG. 38B is a block diagram of a control circuit of the surgicalinstrument of FIG. 34 spanning two drawing sheets, in accordance with atleast one aspect of the present disclosure.

FIG. 39 is a block diagram of the control circuit of the surgicalinstrument of FIG. 34 illustrating interfaces between the handleassembly, the power assembly, and the handle assembly and theinterchangeable shaft assembly, in accordance with at least one aspectof the present disclosure.

FIG. 40 illustrates a logic flow diagram of a process depicting acontrol program or a logic configuration for marking tissue, inaccordance with at least one aspect of the present disclosure.

FIG. 41 illustrates a jaw member of an end effector that includes astaple cartridge, in accordance with at least one aspect of the presentdisclosure.

FIG. 42 illustrates a jaw member of an end effector of an ultrasonicsurgical instrument, in accordance with at least one aspect of thepresent disclosure.

FIG. 43 illustrates an end effector of a surgical stapling and cuttinginstrument, in accordance with at least one aspect of the presentdisclosure.

FIG. 44 illustrates a control system of a surgical instrument, inaccordance with at least one aspect of the present disclosure.

FIG. 45 illustrates tissue treatments applied to tissue to remove acancerous portion of a colon, in accordance with at least one aspect ofthe present disclosure.

FIG. 46 is a graph illustrating force-to-clamp (FTC) and force-to-fire(FTF) readings for a powered surgical instrument during a surgicalprocedure, and corresponding communication rates of transmission of thereadings to a surgical hub, the readings and the communication ratesbeing plotted against time, in accordance with at least one aspect ofthe present disclosure.

FIG. 47 illustrates transmission rates for FTC data and FTF data at fourexample points in the graph of FIG. 46 , in accordance with at least oneaspect of the present disclosure.

FIG. 48 illustrates a logic flow diagram of a process depicting acontrol program or a logic configuration for coordinating transmissionof data between a powered surgical instrument and a surgical hub, inaccordance with at least one aspect of the present disclosure.

FIG. 49 is a control system of the powered surgical instrument of FIG.46 , in accordance with at least one aspect of the present disclosure.

FIG. 50 illustrates a logic flow diagram of a process depicting acontrol program or a logic configuration for coordinating transmissionof data between a powered surgical instrument and a surgical hub, inaccordance with at least one aspect of the present disclosure.

FIG. 51 is a timeline depicting situational awareness of a surgical hub,in accordance with at least one aspect of the present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. patentapplications, filed on Dec. 4, 2018, the disclosures of each of whichare herein incorporated by reference in their entireties:

-   -   application Ser. No. 16/209,385, titled METHOD OF HUB        COMMUNICATION, PROCESSING, STORAGE AND DISPLAY, now U.S. Patent        Application Publication No. 2019/0200844;    -   application Ser. No. 16/209,395, titled METHOD OF HUB        COMMUNICATION, now U.S. Patent Application Publication No.        2019/0201136;    -   Application Ser. No. 16/209,403, titled METHOD OF CLOUD BASED        DATA ANALYTICS FOR USE WITH THE HUB, now U.S. Patent Application        Publication No. 2019/0206569;    -   application Ser. No. 16/209,407, titled METHOD OF ROBOTIC HUB        COMMUNICATION, DETECTION, AND CONTROL, now U.S. Patent        Application Publication No. 2019/0201137;    -   application Ser. No. 16/209,416, titled METHOD OF HUB        COMMUNICATION, PROCESSING, DISPLAY, AND CLOUD ANALYTICS, now        U.S. Patent Application Publication No. 2019/0206562;    -   application Ser. No. 16/209,423, titled METHOD OF COMPRESSING        TISSUE WITHIN A STAPLING DEVICE AND SIMULTANEOUSLY DISPLAYING        THE LOCATION OF THE TISSUE WITHIN THE JAWS, now U.S. Patent        Application Publication No. 2019/0200981;    -   application Ser. No. 16/209,433, titled METHOD OF SENSING        PARTICULATE FROM SMOKE EVACUATED FROM A PATIENT, ADJUSTING THE        PUMP SPEED BASED ON THE SENSED INFORMATION, AND COMMUNICATING        THE FUNCTIONAL PARAMETERS OF THE SYSTEM TO THE HUB, now U.S.        Patent Application Publication No. 2019/0201594;    -   application Ser. No. 16/209,447, titled METHOD FOR SMOKE        EVACUATION FOR SURGICAL HUB, now U.S. Patent Application        Publication No. 2019/0201045;    -   application Ser. No. 16/209,453, titled METHOD FOR CONTROLLING        SMART ENERGY DEVICES, now U.S. Patent Application Publication        No. 2019/0201046;    -   application Ser. No. 16/209,458, titled METHOD FOR SMART ENERGY        DEVICE INFRASTRUCTURE, now U.S. Patent Application Publication        No. 2019/0201047;    -   application Ser. No. 16/209,465, titled METHOD FOR ADAPTIVE        CONTROL SCHEMES FOR SURGICAL NETWORK CONTROL AND INTERACTION,        now U.S. Pat. No. 11,304,699;    -   application Ser. No. 16/209,478, titled METHOD FOR SITUATIONAL        AWARENESS FOR SURGICAL NETWORK OR SURGICAL NETWORK CONNECTED        DEVICE CAPABLE OF ADJUSTING FUNCTION BASED ON A SENSED SITUATION        OR USAGE, now U.S. Patent Application Publication No.        2019/0104919;    -   application Ser. No. 16/209,490, titled METHOD FOR FACILITY DATA        COLLECTION AND INTERPRETATION, now U.S. Patent Application        Publication No. 2019/0206564; and    -   application Ser. No. 16/209,491, titled METHOD FOR CIRCULAR        STAPLER CONTROL ALGORITHM ADJUSTMENT BASED ON SITUATIONAL        AWARENESS, now U.S. Pat. No. 11,109,866.

Applicant of the present application owns the following U.S. patentapplications, filed on Nov. 6, 2018, the disclosure of each of which isherein incorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/182,224, titled SURGICAL        NETWORK, INSTRUMENT, AND CLOUD RESPONSES BASED ON VALIDATION OF        RECEIVED DATASET AND AUTHENTICATION OF ITS SOURCE AND INTEGRITY;    -   U.S. patent application Ser. No. 16/182,230, titled SURGICAL        SYSTEM FOR PRESENTING INFORMATION INTERPRETED FROM EXTERNAL        DATA;    -   U.S. patent application Ser. No. 16/182,233, titled SURGICAL        SYSTEMS WITH AUTONOMOUSLY ADJUSTABLE CONTROL PROGRAMS;    -   U.S. patent application Ser. No. 16/182,239, titled ADJUSTMENT        OF DEVICE CONTROL PROGRAMS BASED ON STRATIFIED CONTEXTUAL DATA        IN ADDITION TO THE DATA;    -   U.S. patent application Ser. No. 16/182,243, titled SURGICAL HUB        AND MODULAR DEVICE RESPONSE ADJUSTMENT BASED ON SITUATIONAL        AWARENESS;    -   U.S. patent application Ser. No. 16/182,248, titled DETECTION        AND ESCALATION OF SECURITY RESPONSES OF SURGICAL INSTRUMENTS TO        INCREASING SEVERITY THREATS;    -   U.S. patent application Ser. No. 16/182,251, titled INTERACTIVE        SURGICAL SYSTEM;    -   U.S. patent application Ser. No. 16/182,260, titled AUTOMATED        DATA SCALING, ALIGNMENT, AND ORGANIZING BASED ON PREDEFINED        PARAMETERS WITHIN SURGICAL NETWORKS;    -   U.S. patent application Ser. No. 16/182,267, titled SENSING THE        PATIENT POSITION AND CONTACT UTILIZING THE MONO-POLAR RETURN PAD        ELECTRODE TO PROVIDE SITUATIONAL AWARENESS TO THE HUB;    -   U.S. patent application Ser. No. 16/182,249, titled POWERED        SURGICAL TOOL WITH PREDEFINED ADJUSTABLE CONTROL ALGORITHM FOR        CONTROLLING END EFFECTOR PARAMETER;    -   U.S. patent application Ser. No. 16/182,246, titled ADJUSTMENTS        BASED ON AIRBORNE PARTICLE PROPERTIES;    -   U.S. patent application Ser. No. 16/182,256, titled ADJUSTMENT        OF A SURGICAL DEVICE FUNCTION BASED ON SITUATIONAL AWARENESS;    -   U.S. patent application Ser. No. 16/182,242, titled REAL-TIME        ANALYSIS OF COMPREHENSIVE COST OF ALL INSTRUMENTATION USED IN        SURGERY UTILIZING DATA FLUIDITY TO TRACK INSTRUMENTS THROUGH        STOCKING AND IN-HOUSE PROCESSES;    -   U.S. patent application Ser. No. 16/182,255, titled USAGE AND        TECHNIQUE ANALYSIS OF SURGEON/STAFF PERFORMANCE AGAINST A        BASELINE TO OPTIMIZE DEVICE UTILIZATION AND PERFORMANCE FOR BOTH        CURRENT AND FUTURE PROCEDURES;    -   U.S. patent application Ser. No. 16/182,269, titled IMAGE        CAPTURING OF THE AREAS OUTSIDE THE ABDOMEN TO IMPROVE PLACEMENT        AND CONTROL OF A SURGICAL DEVICE IN USE;    -   U.S. patent application Ser. No. 16/182,278, titled        COMMUNICATION OF DATA WHERE A SURGICAL NETWORK IS USING CONTEXT        OF THE DATA AND REQUIREMENTS OF A RECEIVING SYSTEM/USER TO        INFLUENCE INCLUSION OR LINKAGE OF DATA AND METADATA TO ESTABLISH        CONTINUITY;    -   U.S. patent application Ser. No. 16/182,290, titled SURGICAL        NETWORK RECOMMENDATIONS FROM REAL TIME ANALYSIS OF PROCEDURE        VARIABLES AGAINST A BASELINE HIGHLIGHTING DIFFERENCES FROM THE        OPTIMAL SOLUTION;    -   U.S. patent application Ser. No. 16/182,232, titled CONTROL OF A        SURGICAL SYSTEM THROUGH A SURGICAL BARRIER;    -   U.S. patent application Ser. No. 16/182,227, titled SURGICAL        NETWORK DETERMINATION OF PRIORITIZATION OF COMMUNICATION,        INTERACTION, OR PROCESSING BASED ON SYSTEM OR DEVICE NEEDS;    -   U.S. patent application Ser. No. 16/182,231, titled WIRELESS        PAIRING OF A SURGICAL DEVICE WITH ANOTHER DEVICE WITHIN A        STERILE SURGICAL FIELD BASED ON THE USAGE AND SITUATIONAL        AWARENESS OF DEVICES;    -   U.S. patent application Ser. No. 16/182,229, titled ADJUSTMENT        OF STAPLE HEIGHT OF AT LEAST ONE ROW OF STAPLES BASED ON THE        SENSED TISSUE THICKNESS OR FORCE IN CLOSING;    -   U.S. patent application Ser. No. 16/182,234, titled STAPLING        DEVICE WITH BOTH COMPULSORY AND DISCRETIONARY LOCKOUTS BASED ON        SENSED PARAMETERS;    -   U.S. patent application Ser. No. 16/182,240, titled POWERED        STAPLING DEVICE CONFIGURED TO ADJUST FORCE, ADVANCEMENT SPEED,        AND OVERALL STROKE OF CUTTING MEMBER BASED ON SENSED PARAMETER        OF FIRING OR CLAMPING;    -   U.S. patent application Ser. No. 16/182,235, titled VARIATION OF        RADIO FREQUENCY AND ULTRASONIC POWER LEVEL IN COOPERATION WITH        VARYING CLAMP ARM PRESSURE TO ACHIEVE PREDEFINED HEAT FLUX OR        POWER APPLIED TO TISSUE; and    -   U.S. patent application Ser. No. 16/182,238, titled ULTRASONIC        ENERGY DEVICE WHICH VARIES PRESSURE APPLIED BY CLAMP ARM TO        PROVIDE THRESHOLD CONTROL PRESSURE AT A CUT PROGRESSION        LOCATION.

Applicant of the present application owns the following U.S. patentapplications that were filed on Oct. 26, 2018, the disclosure of each ofwhich is herein incorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/172,303, titled METHOD FOR        OPERATING A POWERED ARTICULATING MULTI-CLIP APPLIER;    -   U.S. patent application Ser. No. 16/172,130, titled CLIP APPLIER        COMPRISING INTERCHANGEABLE CLIP RELOADS;    -   U.S. patent application Ser. No. 16/172,066, titled CLIP APPLIER        COMPRISING A MOVABLE CLIP MAGAZINE;    -   U.S. patent application Ser. No. 16/172,078, titled CLIP APPLIER        COMPRISING A ROTATABLE CLIP MAGAZINE;    -   U.S. patent application Ser. No. 16/172,087, titled CLIP APPLIER        COMPRISING CLIP ADVANCING SYSTEMS;    -   U.S. patent application Ser. No. 16/172,094, titled CLIP APPLIER        COMPRISING A CLIP CRIMPING SYSTEM;    -   U.S. patent application Ser. No. 16/172,128, titled CLIP APPLIER        COMPRISING A RECIPROCATING CLIP ADVANCING MEMBER;    -   U.S. patent application Ser. No. 16/172,168, titled CLIP APPLIER        COMPRISING A MOTOR CONTROLLER;    -   U.S. patent application Ser. No. 16/172,164, titled SURGICAL        SYSTEM COMPRISING A SURGICAL TOOL AND A SURGICAL HUB;    -   U.S. patent application Ser. No. 16/172,328, titled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS;    -   U.S. patent application Ser. No. 16/172,280, titled METHOD FOR        PRODUCING A SURGICAL INSTRUMENT COMPRISING A SMART ELECTRICAL        SYSTEM;    -   U.S. patent application Ser. No. 16/172,219, titled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS;    -   U.S. patent application Ser. No. 16/172,248, titled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS;    -   U.S. patent application Ser. No. 16/172,198, titled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS; and    -   U.S. patent application Ser. No. 16/172,155, titled METHOD OF        HUB COMMUNICATION WITH SURGICAL INSTRUMENT SYSTEMS.

Applicant of the present application owns the following U.S. patentapplications, filed on Aug. 28, 2018, the disclosure of each of which isherein incorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/115,214, titled ESTIMATING        STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;    -   U.S. patent application Ser. No. 16/115,205, titled TEMPERATURE        CONTROL OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM THEREFOR;    -   U.S. patent application Ser. No. 16/115,233, titled RADIO        FREQUENCY ENERGY DEVICE FOR DELIVERING COMBINED ELECTRICAL        SIGNALS;    -   U.S. patent application Ser. No. 16/115,208, titled CONTROLLING        AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO TISSUE LOCATION;    -   U.S. patent application Ser. No. 16/115,220, titled CONTROLLING        ACTIVATION OF AN ULTRASONIC SURGICAL INSTRUMENT ACCORDING TO THE        PRESENCE OF TISSUE;    -   U.S. patent application Ser. No. 16/115,232, titled DETERMINING        TISSUE COMPOSITION VIA AN ULTRASONIC SYSTEM;    -   U.S. patent application Ser. No. 16/115,239, titled DETERMINING        THE STATE OF AN ULTRASONIC ELECTROMECHANICAL SYSTEM ACCORDING TO        FREQUENCY SHIFT;    -   U.S. patent application Ser. No. 16/115,247, titled DETERMINING        THE STATE OF AN ULTRASONIC END EFFECTOR;    -   U.S. patent application Ser. No. 16/115,211, titled SITUATIONAL        AWARENESS OF ELECTROSURGICAL SYSTEMS;    -   U.S. patent application Ser. No. 16/115,226, titled MECHANISMS        FOR CONTROLLING DIFFERENT ELECTROMECHANICAL SYSTEMS OF AN        ELECTROSURGICAL INSTRUMENT;    -   U.S. patent application Ser. No. 16/115,240, titled DETECTION OF        END EFFECTOR EMERSION IN LIQUID;    -   U.S. patent application Ser. No. 16/115,249, titled INTERRUPTION        OF ENERGY DUE TO INADVERTENT CAPACITIVE COUPLING;    -   U.S. patent application Ser. No. 16/115,256, titled INCREASING        RADIO FREQUENCY TO CREATE PAD-LESS MONOPOLAR LOOP;    -   U.S. patent application Ser. No. 16/115,223, titled BIPOLAR        COMBINATION DEVICE THAT AUTOMATICALLY ADJUSTS PRESSURE BASED ON        ENERGY MODALITY; and    -   U.S. patent application Ser. No. 16/115,238, titled ACTIVATION        OF ENERGY DEVICES.

Applicant of the present application owns the following U.S. patentapplications, filed on Aug. 24, 2018, the disclosure of each of which isherein incorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/112,129, titled SURGICAL        SUTURING INSTRUMENT CONFIGURED TO MANIPULATE TISSUE USING        MECHANICAL AND ELECTRICAL POWER;    -   U.S. patent application Ser. No. 16/112,155, titled SURGICAL        SUTURING INSTRUMENT COMPRISING A CAPTURE WIDTH WHICH IS LARGER        THAN TROCAR DIAMETER;    -   U.S. patent application Ser. No. 16/112,168, titled SURGICAL        SUTURING INSTRUMENT COMPRISING A NON-CIRCULAR NEEDLE;    -   U.S. patent application Ser. No. 16/112,180, titled ELECTRICAL        POWER OUTPUT CONTROL BASED ON MECHANICAL FORCES;    -   U.S. patent application Ser. No. 16/112,193, titled REACTIVE        ALGORITHM FOR SURGICAL SYSTEM;    -   U.S. patent application Ser. No. 16/112,099, titled SURGICAL        INSTRUMENT COMPRISING AN ADAPTIVE ELECTRICAL SYSTEM;    -   U.S. patent application Ser. No. 16/112,112, titled CONTROL        SYSTEM ARRANGEMENTS FOR A MODULAR SURGICAL INSTRUMENT;    -   U.S. patent application Ser. No. 16/112,119, titled ADAPTIVE        CONTROL PROGRAMS FOR A SURGICAL SYSTEM COMPRISING MORE THAN ONE        TYPE OF CARTRIDGE;    -   U.S. patent application Ser. No. 16/112,097, titled SURGICAL        INSTRUMENT SYSTEMS COMPRISING BATTERY ARRANGEMENTS;    -   U.S. patent application Ser. No. 16/112,109, titled SURGICAL        INSTRUMENT SYSTEMS COMPRISING HANDLE ARRANGEMENTS;    -   U.S. patent application Ser. No. 16/112,114, titled SURGICAL        INSTRUMENT SYSTEMS COMPRISING FEEDBACK MECHANISMS;    -   U.S. patent application Ser. No. 16/112,117, titled SURGICAL        INSTRUMENT SYSTEMS COMPRISING LOCKOUT MECHANISMS;    -   U.S. patent application Ser. No. 16/112,095, titled SURGICAL        INSTRUMENTS COMPRISING A LOCKABLE END EFFECTOR SOCKET;    -   U.S. patent application Ser. No. 16/112,121, titled SURGICAL        INSTRUMENTS COMPRISING A SHIFTING MECHANISM;    -   U.S. patent application Ser. No. 16/112,151, titled SURGICAL        INSTRUMENTS COMPRISING A SYSTEM FOR ARTICULATION AND ROTATION        COMPENSATION;    -   U.S. patent application Ser. No. 16/112,154, titled SURGICAL        INSTRUMENTS COMPRISING A BIASED SHIFTING MECHANISM;    -   U.S. patent application Ser. No. 16/112,226, titled SURGICAL        INSTRUMENTS COMPRISING AN ARTICULATION DRIVE THAT PROVIDES FOR        HIGH ARTICULATION ANGLES;    -   U.S. patent application Ser. No. 16/112,062, titled SURGICAL        DISSECTORS AND MANUFACTURING TECHNIQUES;    -   U.S. patent application Ser. No. 16/112,098, titled SURGICAL        DISSECTORS CONFIGURED TO APPLY MECHANICAL AND ELECTRICAL ENERGY;    -   U.S. patent application Ser. No. 16/112,237, titled SURGICAL        CLIP APPLIER CONFIGURED TO STORE CLIPS IN A STORED STATE;    -   U.S. patent application Ser. No. 16/112,245, titled SURGICAL        CLIP APPLIER COMPRISING AN EMPTY CLIP CARTRIDGE LOCKOUT;    -   U.S. patent application Ser. No. 16/112,249, titled SURGICAL        CLIP APPLIER COMPRISING AN AUTOMATIC CLIP FEEDING SYSTEM;    -   U.S. patent application Ser. No. 16/112,253, titled SURGICAL        CLIP APPLIER COMPRISING ADAPTIVE FIRING CONTROL; and    -   U.S. patent application Ser. No. 16/112,257, titled SURGICAL        CLIP APPLIER COMPRISING ADAPTIVE CONTROL IN RESPONSE TO A STRAIN        GAUGE CIRCUIT.

Applicant of the present application owns the following U.S. patentapplications, filed on Jun. 29, 2018, the disclosure of each of which isherein incorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/024,090, titled CAPACITIVE        COUPLED RETURN PATH PAD WITH SEPARABLE ARRAY ELEMENTS;    -   U.S. patent application Ser. No. 16/024,057, titled CONTROLLING        A SURGICAL INSTRUMENT ACCORDING TO SENSED CLOSURE PARAMETERS;    -   U.S. patent application Ser. No. 16/024,067, titled SYSTEMS FOR        ADJUSTING END EFFECTOR PARAMETERS BASED ON PERIOPERATIVE        INFORMATION;    -   U.S. patent application Ser. No. 16/024,075, titled SAFETY        SYSTEMS FOR SMART POWERED SURGICAL STAPLING;    -   U.S. patent application Ser. No. 16/024,083, titled SAFETY        SYSTEMS FOR SMART POWERED SURGICAL STAPLING;    -   U.S. patent application Ser. No. 16/024,094, titled SURGICAL        SYSTEMS FOR DETECTING END EFFECTOR TISSUE DISTRIBUTION        IRREGULARITIES;    -   U.S. patent application Ser. No. 16/024,138, titled SYSTEMS FOR        DETECTING PROXIMITY OF SURGICAL END EFFECTOR TO CANCEROUS        TISSUE;    -   U.S. patent application Ser. No. 16/024,150, titled SURGICAL        INSTRUMENT CARTRIDGE SENSOR ASSEMBLIES;    -   U.S. patent application Ser. No. 16/024,160, titled VARIABLE        OUTPUT CARTRIDGE SENSOR ASSEMBLY;    -   U.S. patent application Ser. No. 16/024,124, titled SURGICAL        INSTRUMENT HAVING A FLEXIBLE ELECTRODE;    -   U.S. patent application Ser. No. 16/024,132, titled SURGICAL        INSTRUMENT HAVING A FLEXIBLE CIRCUIT;    -   U.S. patent application Ser. No. 16/024,141, titled SURGICAL        INSTRUMENT WITH A TISSUE MARKING ASSEMBLY;    -   U.S. patent application Ser. No. 16/024,162, titled SURGICAL        SYSTEMS WITH PRIORITIZED DATA TRANSMISSION CAPABILITIES;    -   U.S. patent application Ser. No. 16/024,066, titled SURGICAL        EVACUATION SENSING AND MOTOR CONTROL;    -   U.S. patent application Ser. No. 16/024,096, titled SURGICAL        EVACUATION SENSOR ARRANGEMENTS;    -   U.S. patent application Ser. No. 16/024,116, titled SURGICAL        EVACUATION FLOW PATHS;    -   U.S. patent application Ser. No. 16/024,149, titled SURGICAL        EVACUATION SENSING AND GENERATOR CONTROL;    -   U.S. patent application Ser. No. 16/024,180, titled SURGICAL        EVACUATION SENSING AND DISPLAY;    -   U.S. patent application Ser. No. 16/024,245, titled        COMMUNICATION OF SMOKE EVACUATION SYSTEM PARAMETERS TO HUB OR        CLOUD IN SMOKE EVACUATION MODULE FOR INTERACTIVE SURGICAL        PLATFORM;    -   U.S. patent application Ser. No. 16/024,258, titled SMOKE        EVACUATION SYSTEM INCLUDING A SEGMENTED CONTROL CIRCUIT FOR        INTERACTIVE SURGICAL PLATFORM;    -   U.S. patent application Ser. No. 16/024,265, titled SURGICAL        EVACUATION SYSTEM WITH A COMMUNICATION CIRCUIT FOR COMMUNICATION        BETWEEN A FILTER AND A SMOKE EVACUATION DEVICE; and    -   U.S. patent application Ser. No. 16/024,273, titled DUAL        IN-SERIES LARGE AND SMALL DROPLET FILTERS.

Applicant of the present application owns the following U.S. patentapplications, filed on Mar. 29, 2018, the disclosure of each of which isherein incorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,641, titled INTERACTIVE        SURGICAL SYSTEMS WITH ENCRYPTED COMMUNICATION CAPABILITIES;    -   U.S. patent application Ser. No. 15/940,648, titled INTERACTIVE        SURGICAL SYSTEMS WITH CONDITION HANDLING OF DEVICES AND DATA        CAPABILITIES;    -   U.S. patent application Ser. No. 15/940,656, titled SURGICAL HUB        COORDINATION OF CONTROL AND COMMUNICATION OF OPERATING ROOM        DEVICES;    -   U.S. patent application Ser. No. 15/940,666, titled SPATIAL        AWARENESS OF SURGICAL HUBS IN OPERATING ROOMS;    -   U.S. patent application Ser. No. 15/940,670, titled COOPERATIVE        UTILIZATION OF DATA DERIVED FROM SECONDARY SOURCES BY        INTELLIGENT SURGICAL HUBS;    -   U.S. patent application Ser. No. 15/940,677, titled SURGICAL HUB        CONTROL ARRANGEMENTS;    -   U.S. patent application Ser. No. 15/940,632, titled DATA        STRIPPING METHOD TO INTERROGATE PATIENT RECORDS AND CREATE        ANONYMIZED RECORD;    -   U.S. patent application Ser. No. 15/940,640, titled        COMMUNICATION HUB AND STORAGE DEVICE FOR STORING PARAMETERS AND        STATUS OF A SURGICAL DEVICE TO BE SHARED WITH CLOUD BASED        ANALYTICS SYSTEMS;    -   U.S. patent application Ser. No. 15/940,645, titled SELF        DESCRIBING DATA PACKETS GENERATED AT AN ISSUING INSTRUMENT;    -   U.S. patent application Ser. No. 15/940,649, titled DATA PAIRING        TO INTERCONNECT A DEVICE MEASURED PARAMETER WITH AN OUTCOME;    -   U.S. patent application Ser. No. 15/940,654, titled SURGICAL HUB        SITUATIONAL AWARENESS;    -   U.S. patent application Ser. No. 15/940,663, titled SURGICAL        SYSTEM DISTRIBUTED PROCESSING;    -   U.S. patent application Ser. No. 15/940,668, titled AGGREGATION        AND REPORTING OF SURGICAL HUB DATA;    -   U.S. patent application Ser. No. 15/940,671, titled SURGICAL HUB        SPATIAL AWARENESS TO DETERMINE DEVICES IN OPERATING THEATER;    -   U.S. patent application Ser. No. 15/940,686, titled DISPLAY OF        ALIGNMENT OF STAPLE CARTRIDGE TO PRIOR LINEAR STAPLE LINE;    -   U.S. patent application Ser. No. 15/940,700, titled STERILE        FIELD INTERACTIVE CONTROL DISPLAYS;    -   U.S. patent application Ser. No. 15/940,629, titled COMPUTER        IMPLEMENTED INTERACTIVE SURGICAL SYSTEMS;    -   U.S. patent application Ser. No. 15/940,704, titled USE OF LASER        LIGHT AND RED-GREEN-BLUE COLORATION TO DETERMINE PROPERTIES OF        BACK SCATTERED LIGHT;    -   U.S. patent application Ser. No. 15/940,722, titled        CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF        MONO-CHROMATIC LIGHT REFRACTIVITY;    -   U.S. patent application Ser. No. 15/940,742, titled DUAL CMOS        ARRAY IMAGING;    -   U.S. patent application Ser. No. 15/940,636, titled ADAPTIVE        CONTROL PROGRAM UPDATES FOR SURGICAL DEVICES;    -   U.S. patent application Ser. No. 15/940,653, titled ADAPTIVE        CONTROL PROGRAM UPDATES FOR SURGICAL HUBS;    -   U.S. patent application Ser. No. 15/940,660, titled CLOUD-BASED        MEDICAL ANALYTICS FOR CUSTOMIZATION AND RECOMMENDATIONS TO A        USER;    -   U.S. patent application Ser. No. 15/940,679, titled CLOUD-BASED        MEDICAL ANALYTICS FOR LINKING OF LOCAL USAGE TRENDS WITH THE        RESOURCE ACQUISITION BEHAVIORS OF LARGER DATA SET;    -   U.S. patent application Ser. No. 15/940,694, titled CLOUD-BASED        MEDICAL ANALYTICS FOR MEDICAL FACILITY SEGMENTED        INDIVIDUALIZATION OF INSTRUMENT FUNCTION;    -   U.S. patent application Ser. No. 15/940,634, titled CLOUD-BASED        MEDICAL ANALYTICS FOR SECURITY AND AUTHENTICATION TRENDS AND        REACTIVE MEASURES;    -   U.S. patent application Ser. No. 15/940,706, titled DATA        HANDLING AND PRIORITIZATION IN A CLOUD ANALYTICS NETWORK;    -   U.S. patent application Ser. No. 15/940,675, titled CLOUD        INTERFACE FOR COUPLED SURGICAL DEVICES;    -   U.S. patent application Ser. No. 15/940,627, titled DRIVE        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,637, titled        COMMUNICATION ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL        PLATFORMS;    -   U.S. patent application Ser. No. 15/940,642, titled CONTROLS FOR        ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,676, titled AUTOMATIC        TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,680, titled CONTROLLERS        FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,683, titled COOPERATIVE        SURGICAL ACTIONS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,690, titled DISPLAY        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and    -   U.S. patent application Ser. No. 15/940,711, titled SENSING        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS.

Applicant of the present application owns the following U.S. Provisionalpatent applications, filed on Mar. 8, 2018, the disclosure of each ofwhich is herein incorporated by reference in its entirety:

-   -   U.S. Provisional Patent Application No. 62/640,417, titled        TEMPERATURE CONTROL IN ULTRASONIC DEVICE AND CONTROL SYSTEM        THEREFOR; and    -   U.S. Provisional Patent Application No. 62/640,415, titled        ESTIMATING STATE OF ULTRASONIC END EFFECTOR AND CONTROL SYSTEM        THEREFOR.

It is to be understood that at least some of the figures anddescriptions of the invention have been simplified to illustrateelements that are relevant for a clear understanding of the invention,while eliminating, for purposes of clarity, other elements that those ofordinary skill in the art will appreciate may also comprise a portion ofthe invention. However, because such elements are well known in the art,and because they do not facilitate a better understanding of theinvention, a description of such elements is not provided herein.

In the following detailed description, reference is made to theaccompanying drawings, which form a part hereof In the drawings, similarsymbols and reference characters typically identify similar componentsthroughout several views, unless context dictates otherwise. Theillustrative aspects described in the detailed description, drawings andclaims are not meant to be limiting. Other aspects may be utilized, andother changes may be made, without departing from the scope of thetechnology described herein.

The following description of certain examples of the technology shouldnot be used to limit its scope. Other examples, features, aspects,embodiments, and advantages of the technology will become apparent tothose skilled in the art from the following description, which is by wayof illustration, one of the best modes contemplated for carrying out thetechnology. As will be realized, the technology described herein iscapable of other different and obvious aspects, all without departingfrom the technology. Accordingly, the drawings and descriptions shouldbe regarded as illustrative in nature and not restrictive.

It is further understood that any one or more of the teachings,expressions, aspects, embodiments, examples, etc., described herein maybe combined with any one or more of the other teachings, expressions,aspects, embodiments, examples, etc., that are described herein. Thefollowing described teachings, expressions, aspects, embodiments,examples, etc., should therefore not be viewed in isolation relative toeach other. Various suitable ways in which the teachings herein may becombined will be readily apparent to those of ordinary skill in the artin view of the teachings herein. Such modifications and variations areintended to be included within the scope of the claims.

Before explaining the various aspects of the surgical system, thesurgical instrument, the flexible circuit and the flexible electrodeassembly in detail, it should be noted that the various aspectsdisclosed herein are not limited in their application or use to thedetails of construction and arrangement of parts illustrated in theaccompanying drawings and description. Rather, the disclosed aspects maybe positioned or incorporated in other aspects, embodiments, variations,and modifications thereof and may be practiced or carried out in variousways. Accordingly, aspects of the surgical system, the surgicalinstrument, the flexible circuit, and the flexible electrode assemblydisclosed herein are illustrative in nature and are not meant to limitthe scope or application thereof. Furthermore, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the aspects for the convenience of thereader and are not meant to limit the scope thereof. In addition, itshould be understood that any one or more of the disclosed aspects,expressions of aspects, and/or examples thereof, can be combined withany one or more of the other disclosed aspects, expressions of aspects,and/or examples thereof, without limitation.

Also, in the following description, it is to be understood that termssuch as inward, outward, upward, downward, above, below, left, right,interior, exterior, and the like are words of convenience and are not tobe construed as limiting terms. Terminology used herein is not meant tobe limiting insofar as devices described herein, or portions thereof,may be attached or utilized in other orientations. The various aspectswill be described in more detail with reference to the drawings.

As described in more detail hereinbelow, aspects of the invention may beimplemented by a computing device and/or a computer program stored on acomputer-readable medium. The computer-readable medium may comprise adisk, a device, and/or a propagated signal.

Referring to FIG. 1 , a computer-implemented interactive surgical system100 includes one or more surgical systems 102 and a cloud-based system(e.g., the cloud 104 that may include a remote server 113 coupled to astorage device 105). Each surgical system 102 includes at least onesurgical hub 106 in communication with the cloud 104 that may include aremote server 113. In one example, as illustrated in FIG. 1 , thesurgical system 102 includes a visualization system 108, a roboticsystem 110, and a handheld intelligent surgical instrument 112, whichare configured to communicate with one another and/or surgical hub 106.In some aspects, a surgical system 102 may include an M number of hubs106, an N number of visualization systems 108, an O number of roboticsystems 110, and a P number of handheld intelligent surgical instruments112, where M, N, O, and P are integers greater than or equal to one.

FIG. 3 depicts an example of a surgical system 102 being used to performa surgical procedure on a patient who is lying down on an operatingtable 114 in a surgical operating room 116. A robotic system 110 is usedin the surgical procedure as a part of the surgical system 102. Therobotic system 110 includes a surgeon's console 118, a patient side cart120 (surgical robot), and a surgical robotic hub 122. The patient sidecart 120 can manipulate at least one removably coupled surgical tool 117through a minimally invasive incision in the body of the patient whilethe surgeon views the surgical site through the surgeon's console 118.An image of the surgical site can be obtained by a medical imagingdevice 124, which can be manipulated by the patient side cart 120 toorient the imaging device 124. The robotic hub 122 can be used toprocess the images of the surgical site for subsequent display to thesurgeon through the surgeon's console 118.

Other types of robotic systems can be readily adapted for use with thesurgical system 102. Various examples of robotic systems and surgicaltools that are suitable for use with the present disclosure aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,339,titled ROBOT ASSISTED SURGICAL PLATFORM, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

Various examples of cloud-based analytics that are performed by thecloud 104, and are suitable for use with the present disclosure, aredescribed in U.S. Provisional Patent Application Ser. No. 62/611,340,titled CLOUD-BASED MEDICAL ANALYTICS, filed Dec. 28, 2017, thedisclosure of which is herein incorporated by reference in its entirety.

In various aspects, the imaging device 124 includes at least one imagesensor and one or more optical components. Suitable image sensorsinclude, but are not limited to, Charge-Coupled Device (CCD) sensors andComplementary Metal-Oxide Semiconductor (CMOS) sensors.

The optical components of the imaging device 124 may include one or moreillumination sources and/or one or more lenses. The one or moreillumination sources may be directed to illuminate portions of thesurgical field. The one or more image sensors may receive lightreflected or refracted from the surgical field, including lightreflected or refracted from tissue and/or surgical instruments.

The one or more illumination sources may be configured to radiateelectromagnetic energy in the visible spectrum as well as the invisiblespectrum. The visible spectrum, sometimes referred to as the opticalspectrum or luminous spectrum, is that portion of the electromagneticspectrum that is visible to (i.e., can be detected by) the human eye andmay be referred to as visible light or simply light. A typical human eyewill respond to wavelengths in air that are from about 380 nm to about750 nm.

The invisible spectrum (i.e., the non-luminous spectrum) is that portionof the electromagnetic spectrum that lies below and above the visiblespectrum (i.e., wavelengths below about 380 nm and above about 750 nm).The invisible spectrum is not detectable by the human eye. Wavelengthsgreater than about 750 nm are longer than the red visible spectrum, andthey become invisible infrared (IR), microwave, and radioelectromagnetic radiation. Wavelengths less than about 380 nm areshorter than the violet spectrum, and they become invisible ultraviolet,x-ray, and gamma ray electromagnetic radiation.

In various aspects, the imaging device 124 is configured for use in aminimally invasive procedure. Examples of imaging devices suitable foruse with the present disclosure include, but not limited to, anarthroscope, angioscope, bronchoscope, choledochoscope, colonoscope,cytoscope, duodenoscope, enteroscope, esophagogastro-duodenoscope(gastroscope), endoscope, laryngoscope, nasopharyngo-neproscope,sigmoidoscope, thoracoscope, and ureteroscope.

In one aspect, the imaging device employs multi-spectrum monitoring todiscriminate topography and underlying structures. A multi-spectralimage is one that captures image data within specific wavelength rangesacross the electromagnetic spectrum. The wavelengths may be separated byfilters or by the use of instruments that are sensitive to particularwavelengths, including light from frequencies beyond the visible lightrange, e.g., IR and ultraviolet. Spectral imaging can allow extractionof additional information the human eye fails to capture with itsreceptors for red, green, and blue. The use of multi-spectral imaging isdescribed in greater detail under the heading “Advanced ImagingAcquisition Module” in U.S. Provisional Patent Application Ser. No.62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety. Multi-spectrum monitoring can be a useful tool in relocating asurgical field after a surgical task is completed to perform one or moreof the previously described tests on the treated tissue.

It is axiomatic that strict sterilization of the operating room andsurgical equipment is required during any surgery. The strict hygieneand sterilization conditions required in a “surgical theater,” i.e., anoperating or treatment room, necessitate the highest possible sterilityof all medical devices and equipment. Part of that sterilization processis the need to sterilize anything that comes in contact with the patientor penetrates the sterile field, including the imaging device 124 andits attachments and components. It will be appreciated that the sterilefield may be considered a specified area, such as within a tray or on asterile towel, that is considered free of microorganisms, or the sterilefield may be considered an area, immediately around a patient, who hasbeen prepared for a surgical procedure. The sterile field may includethe scrubbed team members, who are properly attired, and all furnitureand fixtures in the area.

In various aspects, the visualization system 108 includes one or moreimaging sensors, one or more image processing units, one or more storagearrays, and one or more displays that are strategically arranged withrespect to the sterile field, as illustrated in FIG. 2 . In one aspect,the visualization system 108 includes an interface for HL7, PACS, andEMR. Various components of the visualization system 108 are describedunder the heading “Advanced Imaging Acquisition Module” in U.S.Provisional Patent Application Ser. No. 62/611,341, titled INTERACTIVESURGICAL PLATFORM, filed Dec. 28, 2017, the disclosure of which isherein incorporated by reference in its entirety.

As illustrated in FIG. 2 , a primary display 119 is positioned in thesterile field to be visible to an operator at the operating table 114.In addition, a visualization tower 111 is positioned outside the sterilefield. The visualization tower 111 includes a first non-sterile display107 and a second non-sterile display 109, which face away from eachother. The visualization system 108, guided by surgical hub 106, isconfigured to utilize the displays 107, 109, and 119 to coordinateinformation flow to operators inside and outside the sterile field. Forexample, surgical hub 106 may cause the visualization system 108 todisplay a snapshot of a surgical site, as recorded by an imaging device124, on a non-sterile display 107 or 109, while maintaining a live feedof the surgical site on the primary display 119. The snap-shot on thenon-sterile display 107 or 109 can permit a non-sterile operator toperform a diagnostic step relevant to the surgical procedure, forexample.

In one aspect, surgical hub 106 is also configured to route a diagnosticinput or feedback entered by a nonsterile operator at the visualizationtower 111 to the primary display 119 within the sterile field, where itcan be viewed by a sterile operator at the operating table. In oneexample, the input can be in the form of a modification to the snapshotdisplayed on the non-sterile display 107 or 109, which can be routed tothe primary display 119 by surgical hub 106.

Referring to FIG. 2 , a surgical instrument 112 is being used in thesurgical procedure as part of the surgical system 102. Surgical hub 106is also configured to coordinate information flow to a display of thesurgical instrument 112. For example, see U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, the disclosure of which is herein incorporated byreference in its entirety. A diagnostic input or feedback entered by anon-sterile operator at the visualization tower 111 can be routed bysurgical hub 106 to the surgical instrument display 115 within thesterile field, where it can be viewed by the operator of the surgicalinstrument 112. Example surgical instruments that are suitable for usewith the surgical system 102 are described under the heading “SurgicalInstrument Hardware” and in U.S. Provisional Patent Application Ser. No.62/611,341, titled INTERACTIVE SURGICAL PLATFORM, filed Dec. 28, 2017,the disclosure of which is herein incorporated by reference in itsentirety, for example.

Referring now to FIG. 3 , a surgical hub 106 is depicted incommunication with a visualization system 108, a robotic system 110, anda handheld intelligent surgical instrument 112. Surgical hub 106includes a surgical hub display 135, an imaging module 138, a generatormodule 140, a communication module 130, a processor module 132, and astorage array 134. In certain aspects, as illustrated in FIG. 3 ,surgical hub 106 further includes a smoke evacuation module 126 and/or asuction/irrigation module 128.

During a surgical procedure, energy application to tissue, for sealingand/or cutting, is generally associated with smoke evacuation, suctionof excess fluid, and/or irrigation of the tissue. Fluid, power, and/ordata lines from different sources are often entangled during thesurgical procedure. Valuable time can be lost addressing this issueduring a surgical procedure. Detangling the lines may necessitatedisconnecting the lines from their respective modules, which may requireresetting the modules. Surgical hub modular enclosure 136 offers aunified environment for managing the power, data, and fluid lines, whichreduces the frequency of entanglement between such lines.

Aspects of the present disclosure present a surgical hub for use in asurgical procedure that involves energy application to tissue at asurgical site. The surgical hub includes a surgical hub enclosure and acombo generator module slidably receivable in a docking station ofsurgical hub enclosure. The docking station includes data and powercontacts. The combo generator module includes two or more of anultrasonic energy generator component, a bipolar RF energy generatorcomponent, and a monopolar RF energy generator component that are housedin a single unit. In one aspect, the combo generator module alsoincludes a smoke evacuation component, at least one energy deliverycable for connecting the combo generator module to a surgicalinstrument; at least one smoke evacuation component configured toevacuate smoke, fluid, and/or particulates generated by the applicationof therapeutic energy to the tissue; and a fluid line extending from theremote surgical site to the smoke evacuation component.

In one aspect, the fluid line is a first fluid line and a second fluidline extends from the remote surgical site to a suction and irrigationmodule slidably received in surgical hub enclosure. In one aspect,surgical hub enclosure comprises a fluid interface.

Certain surgical procedures may require the application of more than oneenergy type to the tissue. One energy type may be more beneficial forcutting the tissue, while another different energy type may be morebeneficial for sealing the tissue. For example, a bipolar generator canbe used to seal the tissue while an ultrasonic generator can be used tocut the sealed tissue. Aspects of the present disclosure present asolution where a surgical hub modular enclosure 136 is configured toaccommodate different generators, and facilitate an interactivecommunication therebetween. One of the advantages of surgical hubmodular enclosure 136 is enabling the quick removal and/or replacementof various modules.

Aspects of the present disclosure present a modular surgical enclosurefor use in a surgical procedure that involves energy application totissue. The modular surgical enclosure includes a first energy-generatormodule, configured to generate a first energy for application to thetissue, and a first docking station comprising a first docking port thatincludes first data and power contacts, wherein the firstenergy-generator module is slidably movable into an electricalengagement with the power and data contacts and wherein the firstenergy-generator module is slidably movable out of the electricalengagement with the first power and data contacts.

Further to the above, the modular surgical enclosure also includes asecond energy-generator module configured to generate a second energy,different than the first energy, for application to the tissue, and asecond docking station comprising a second docking port that includessecond data and power contacts, wherein the second energy-generatormodule is slidably movable into an electrical engagement with the powerand data contacts, and wherein the second energy-generator module isslidably movable out of the electrical engagement with the second powerand data contacts.

In addition, the modular surgical enclosure also includes acommunication bus between the first docking port and the second dockingport, configured to facilitate communication between the firstenergy-generator module and the second energy-generator module.

Referring to FIGS. 3-7 , aspects of the present disclosure are presentedfor a surgical hub modular enclosure 136 that allows the modularintegration of a generator module 140, a smoke evacuation module 126,and a suction/irrigation module 128. Surgical hub modular enclosure 136further facilitates interactive communication between the modules 140,126, 128. As illustrated in FIG. 5 , the generator module 140 can be agenerator module with integrated monopolar, bipolar, and ultrasoniccomponents supported in a single housing unit 139 slidably insertableinto surgical hub modular enclosure 136. As illustrated in FIG. 5 , thegenerator module 140 can be configured to connect to a monopolar device146, a bipolar device 147, and an ultrasonic device 148. Alternatively,the generator module 140 may comprise a series of monopolar, bipolar,and/or ultrasonic generator modules that interact through surgical hubmodular enclosure 136. Surgical hub modular enclosure 136 can beconfigured to facilitate the insertion of multiple generators andinteractive communication between the generators docked into surgicalhub modular enclosure 136 so that the generators would act as a singlegenerator.

In one aspect, surgical hub modular enclosure 136 comprises a modularpower and communication backplane 149 with external and wirelesscommunication headers to enable the removable attachment of the modules140, 126, 128 and interactive communication therebetween.

In one aspect, surgical hub modular enclosure 136 includes dockingstations, or drawers, 151, herein also referred to as drawers, which areconfigured to slidably receive the modules 140, 126, 128. FIG. 4illustrates a partial perspective view of a surgical hub enclosure 136and a combo generator module 145 slidably receivable in a dockingstation 151 of the surgical hub enclosure 136. A docking port 152 withpower and data contacts on a rear side of the combo generator module 145is configured to engage a corresponding docking port 150 with power anddata contacts of a corresponding docking station 151 of surgical hubmodular enclosure 136 as the combo generator module 145 is slid intoposition within the corresponding docking station 151 of surgical hubmodule enclosure 136. In one aspect, the combo generator module 145includes a bipolar, ultrasonic, and monopolar module and a smokeevacuation module integrated together into a single housing unit 139, asillustrated in FIG. 5 .

In various aspects, the smoke evacuation module 126 includes a fluidline 154 that conveys captured/collected smoke and/or fluid away from asurgical site and to, for example, the smoke evacuation module 126.Vacuum suction originating from the smoke evacuation module 126 can drawthe smoke into an opening of a utility conduit at the surgical site. Theutility conduit, coupled to the fluid line, can be in the form of aflexible tube terminating at the smoke evacuation module 126. Theutility conduit and the fluid line define a fluid path extending towardthe smoke evacuation module 126 that is received in surgical hubenclosure 136.

In various aspects, the suction/irrigation module 128 is coupled to asurgical tool comprising an aspiration fluid line and a suction fluidline. In one example, the aspiration and suction fluid lines are in theform of flexible tubes extending from the surgical site toward thesuction/irrigation module 128. One or more drive systems can beconfigured to cause irrigation and aspiration of fluids to and from thesurgical site.

In one aspect, the surgical tool includes a shaft having an end effectorat a distal end thereof and at least one energy treatment associatedwith the end effector, an aspiration tube, and an irrigation tube. Theaspiration tube can have an inlet port at a distal end thereof and theaspiration tube extends through the shaft. Similarly, an irrigation tubecan extend through the shaft and can have an inlet port in proximity tothe energy deliver implement. The energy deliver implement is configuredto deliver ultrasonic and/or RF energy to the surgical site and iscoupled to the generator module 140 by a cable extending initiallythrough the shaft.

The irrigation tube can be in fluid communication with a fluid source,and the aspiration tube can be in fluid communication with a vacuumsource. The fluid source and/or the vacuum source can be housed in thesuction/irrigation module 128. In one example, the fluid source and/orthe vacuum source can be housed in surgical hub enclosure 136 separatelyfrom the suction/irrigation module 128. In such example, a fluidinterface can be configured to connect the suction/irrigation module 128to the fluid source and/or the vacuum source.

In one aspect, the modules 140, 126, 128 and/or their correspondingdocking stations on surgical hub modular enclosure 136 may includealignment features that are configured to align the docking ports of themodules into engagement with their counterparts in the docking stationsof surgical hub modular enclosure 136. For example, as illustrated inFIG. 4 , the combo generator module 145 includes side brackets 155 thatare configured to slidably engage with corresponding brackets 156 of thecorresponding docking station 151 of surgical hub modular enclosure 136.The brackets cooperate to guide the docking port contacts of the combogenerator module 145 into an electrical engagement with the docking portcontacts of surgical hub modular enclosure 136.

In some aspects, the drawers 151 of surgical hub modular enclosure 136are the same, or substantially the same size, and the modules areadjusted in size to be received in the drawers 151. For example, theside brackets 155 and/or 156 can be larger or smaller depending on thesize of the module. In other aspects, the drawers 151 are different insize and are each designed to accommodate a particular module.

Furthermore, the contacts of a particular module can be keyed forengagement with the contacts of a particular drawer to avoid inserting amodule into a drawer with mismatching contacts.

As illustrated in FIG. 4 , the docking port 150 of one drawer 151 can becoupled to the docking port 150 of another drawer 151 through acommunications link 157 to facilitate an interactive communicationbetween the modules housed in surgical hub modular enclosure 136. Thedocking ports 150 of surgical hub modular enclosure 136 mayalternatively, or additionally, facilitate a wireless interactivecommunication between the modules housed in surgical hub modularenclosure 136. Any suitable wireless communication can be employed, suchas, for example, Air Titan-Bluetooth.

FIG. 6 illustrates individual power bus attachments for a plurality oflateral docking ports of a lateral modular housing 160 configured toreceive a plurality of modules of a surgical hub 206. The lateralmodular housing 160 is configured to laterally receive and interconnectthe modules 161. The modules 161 are slidably inserted into dockingstations 162 of lateral modular housing 160, which includes a backplanefor interconnecting the modules 161. As illustrated in FIG. 6 , themodules 161 are arranged laterally in the lateral modular housing 160.Alternatively, the modules 161 may be arranged vertically in a verticalmodular housing.

FIG. 7 illustrates a vertical modular housing 164 configured to receivea plurality of modules 165 of the surgical hub 106. The modules 165 areslidably inserted into docking stations, or drawers, 167 of verticalmodular housing 164, which includes a backplane for interconnecting themodules 165. Although the drawers 167 of the vertical modular housing164 are arranged vertically, in certain instances, a vertical modularhousing 164 may include drawers that are arranged laterally.Furthermore, the modules 165 may interact with one another through thedocking ports of the vertical modular housing 164. In the example ofFIG. 7 , a display 177 is provided for displaying data relevant to theoperation of the modules 165. In addition, the vertical modular housing164 includes a master module 178 housing a plurality of sub-modules thatare slidably received in the master module 178.

In various aspects, the imaging module 138 comprises an integrated videoprocessor and a modular light source and is adapted for use with variousimaging devices. In one aspect, the imaging device is comprised of amodular housing that can be assembled with a light source module and acamera module. The housing can be a disposable housing. In at least oneexample, the disposable housing is removably coupled to a reusablecontroller, a light source module, and a camera module. The light sourcemodule and/or the camera module can be selectively chosen depending onthe type of surgical procedure. In one aspect, the camera modulecomprises a CCD sensor. In another aspect, the camera module comprises aCMOS sensor. In another aspect, the camera module is configured forscanned beam imaging. Likewise, the light source module can beconfigured to deliver a white light or a different light, depending onthe surgical procedure.

During a surgical procedure, removing a surgical device from thesurgical field and replacing it with another surgical device thatincludes a different camera or a different light source can beinefficient. Temporarily losing sight of the surgical field may lead toundesirable consequences. The module imaging device of the presentdisclosure is configured to permit the replacement of a light sourcemodule or a camera module midstream during a surgical procedure, withouthaving to remove the imaging device from the surgical field.

In one aspect, the imaging device comprises a tubular housing thatincludes a plurality of channels. A first channel is configured toslidably receive the camera module, which can be configured for asnap-fit engagement with the first channel. A second channel isconfigured to slidably receive the light source module, which can beconfigured for a snap-fit engagement with the second channel. In anotherexample, the camera module and/or the light source module can be rotatedinto a final position within their respective channels. A threadedengagement can be employed in lieu of the snap-fit engagement.

In various examples, multiple imaging devices are placed at differentpositions in the surgical field to provide multiple views. The imagingmodule 138 can be configured to switch between the imaging devices toprovide an optimal view. In various aspects, the imaging module 138 canbe configured to integrate the images from the different imaging device.

Various image processors and imaging devices suitable for use with thepresent disclosure are described in U.S. Pat. No. 7,995,045, titledCOMBINED SBI AND CONVENTIONAL IMAGE PROCESSOR, which issued on Aug. 9,2011, which is herein incorporated by reference in its entirety. Inaddition, U.S. Pat. No. 7,982,776, titled SBI MOTION ARTIFACT REMOVALAPPARATUS AND METHOD, which issued on Jul. 19, 2011, which is hereinincorporated by reference in its entirety, describes various systems forremoving motion artifacts from image data. Such systems can beintegrated with the imaging module 138. Furthermore, U.S. PatentApplication Publication No. 2011/0306840, titled CONTROLLABLE MAGNETICSOURCE TO FIXTURE INTRACORPOREAL APPARATUS, published on Dec. 15, 2011,and U.S. Patent Application Publication No. 2014/0243597, titled SYSTEMFOR PERFORMING A MINIMALLY INVASIVE SURGICAL PROCEDURE, published onAug. 28, 2014, the disclosure of each of which is herein incorporated byreference in its entirety.

FIG. 8 illustrates a surgical data network 201 comprising a modularcommunication hub 203 configured to connect modular devices located inone or more operating theaters of a healthcare facility, or any room ina healthcare facility specially equipped for surgical operations, to acloud-based system (e.g., the cloud 204 that may include a remote server213 coupled to a storage device 205 (FIG. 9 )). In one aspect, themodular communication hub 203 comprises a network hub 207 and/or anetwork switch 209 in communication with a network router. The modularcommunication hub 203 also can be coupled to a local computer system 210to provide local computer processing and data manipulation. The surgicaldata network 201 may be configured as passive, intelligent, orswitching. A passive surgical data network serves as a conduit for thedata, enabling it to go from one device (or segment) to another and tothe cloud computing resources. An intelligent surgical data networkincludes additional features to enable the traffic passing through thesurgical data network to be monitored and to configure each port in thenetwork hub 207 or network switch 209. An intelligent surgical datanetwork may be referred to as a manageable hub or switch. A switchinghub reads the destination address of each packet and then forwards thepacket to the correct port.

Modular devices 1 a-1 n located in the operating theater may be coupledto the modular communication hub 203. The network hub 207 and/or thenetwork switch 209 may be coupled to a network router 211 to connect thedevices 1 a-1 n to the cloud 204 or the local computer system 210. Dataassociated with the devices 1 a-1 n may be transferred to cloud-basedcomputers via the router for remote data processing and manipulation.Data associated with the devices 1 a-1 n may also be transferred to thelocal computer system 210 for local data processing and manipulation.Modular devices 2 a-2 m located in the same operating theater also maybe coupled to a network switch 209. The network switch 209 may becoupled to the network hub 207 and/or the network router 211 to connectto the devices 2 a-2 m to the cloud 204. Data associated with thedevices 2 a-2 m may be transferred to the cloud 204 via the networkrouter 211 for data processing and manipulation. Data associated withthe devices 2 a-2 m may also be transferred to the local computer system210 for local data processing and manipulation.

It will be appreciated that the surgical data network 201 may beexpanded by interconnecting multiple network hubs 207 and/or multiplenetwork switches 209 with multiple network routers 211. The modularcommunication hub 203 may be contained in a modular control towerconfigured to receive multiple devices 1 a-1 n/2 a-2 m. The localcomputer system 210 also may be contained in a modular control tower.The modular communication hub 203 is connected to a display 212 todisplay images obtained by some of the devices 1 a-1 n/2 a-2 m, forexample during surgical procedures. In various aspects, the devices 1a-1 n/2 a-2 m may include, for example, various modules such as animaging module 138 coupled to an endoscope, a generator module 140coupled to an energy-based surgical device, a smoke evacuation module126, a suction/irrigation module 128, a communication module 130, aprocessor module 132, a storage array 134, a surgical device coupled toa display, and/or a non-contact sensor module, among other modulardevices that may be connected to the modular communication hub 203 ofthe surgical data network 201.

In one aspect, the surgical data network 201 may comprise a combinationof network hub(s), network switch(es), and network router(s) connectingthe devices 1 a-1 n/2 a-2 m to the cloud. Any one of or all of thedevices 1 a-1 n/2 a-2 m coupled to the network hub or network switch maycollect data in real time and transfer the data to cloud computers fordata processing and manipulation. It will be appreciated that cloudcomputing relies on sharing computing resources rather than having localservers or personal devices to handle software applications. The word“cloud” may be used as a metaphor for “the Internet,” although the termis not limited as such. Accordingly, the term “cloud computing” may beused herein to refer to “a type of Internet-based computing,” wheredifferent services—such as servers, storage, and applications—aredelivered to the modular communication hub 203 and/or computer system210 located in the surgical theater (e.g., a fixed, mobile, temporary,or field operating room or space) and to devices connected to themodular communication hub 203 and/or computer system 210 through theInternet. The cloud infrastructure may be maintained by a cloud serviceprovider. In this context, the cloud service provider may be the entitythat coordinates the usage and control of the devices 1 a-1 n/2 a-2 mlocated in one or more operating theaters. The cloud computing servicescan perform a large number of calculations based on the data gathered bysmart surgical instruments, robots, and other computerized deviceslocated in the operating theater. Surgical hub hardware enables multipledevices or connections to be connected to a computer that communicateswith the cloud computing resources and storage.

Applying cloud computer data processing techniques on the data collectedby the devices 1 a-1 n/2 a-2 m, the surgical data network providesimproved surgical outcomes, reduced costs, and improved patientsatisfaction. At least some of the devices 1 a-1 n/2 a-2 m may beemployed to view tissue states to assess leaks or perfusion of sealedtissue after a tissue sealing and cutting procedure. At least some ofthe devices 1 a-1 n/2 a-2 m may be employed to identify pathology, suchas the effects of diseases, using the cloud-based computing to examinedata including images of samples of body tissue for diagnostic purposes.This includes localization and margin confirmation of tissue andphenotypes. At least some of the devices 1 a-1 n/2 a-2 m may be employedto identify anatomical structures of the body using a variety of sensorsintegrated with imaging devices and techniques such as overlaying imagescaptured by multiple imaging devices. The data gathered by the devices 1a-1 n/2 a-2 m, including image data, may be transferred to the cloud 204or the local computer system 210 or both for data processing andmanipulation including image processing and manipulation. The data maybe analyzed to improve surgical procedure outcomes by determining iffurther treatment, such as the application of endoscopic intervention,emerging technologies, a targeted radiation, targeted intervention, andprecise robotics to tissue-specific sites and conditions, may bepursued. Such data analysis may further employ outcome analyticsprocessing, and using standardized approaches may provide beneficialfeedback to either confirm surgical treatments and the behavior of thesurgeon or suggest modifications to surgical treatments and the behaviorof the surgeon.

In one implementation, the operating theater devices 1 a-1 n may beconnected to the modular communication hub 203 over a wired channel or awireless channel depending on the configuration of the devices 1 a-1 nto a network hub. The network hub 207 may be implemented, in one aspect,as a local network broadcast device that works on the physical layer ofthe Open System Interconnection (OSI) model. The network hub providesconnectivity to the devices 1 a-1 n located in the same operatingtheater network. The network hub 207 collects data in the form ofpackets and sends them to the router in half duplex mode. The networkhub 207 does not store any media access control/Internet protocol(MAC/TP) to transfer the device data. Only one of the devices 1 a-1 ncan send data at a time through the network hub 207. The network hub 207has no routing tables or intelligence regarding where to sendinformation and broadcasts all network data across each connection andto a remote server 213 (FIG. 9 ) over the cloud 204. The network hub 207can detect basic network errors such as collisions, but having allinformation broadcast to multiple ports can be a security risk and causebottlenecks.

In another implementation, the operating theater devices 2 a-2 m may beconnected to a network switch 209 over a wired channel or a wirelesschannel. The network switch 209 works in the data link layer of the OSImodel. The network switch 209 is a multicast device for connecting thedevices 2 a-2 m located in the same operating theater to the network.The network switch 209 sends data in the form of frames to the networkrouter 211 and works in full duplex mode. Multiple devices 2 a-2 m cansend data at the same time through the network switch 209. The networkswitch 209 stores and uses MAC addresses of the devices 2 a-2 m totransfer data.

The network hub 207 and/or the network switch 209 are coupled to thenetwork router 211 for connection to the cloud 204. The network router211 works in the network layer of the OSI model. The network router 211creates a route for transmitting data packets received from the networkhub 207 and/or network switch 211 to cloud-based computer resources forfurther processing and manipulation of the data collected by any one ofor all the devices 1 a-1 n/2 a-2 m. The network router 211 may beemployed to connect two or more different networks located in differentlocations, such as, for example, different operating theaters of thesame healthcare facility or different networks located in differentoperating theaters of different healthcare facilities. The networkrouter 211 sends data in the form of packets to the cloud 204 and worksin full duplex mode. Multiple devices can send data at the same time.The network router 211 uses IP addresses to transfer data.

In one example, the network hub 207 may be implemented as a USB hub,which allows multiple USB devices to be connected to a host computer.The USB hub may expand a single USB port into several tiers so thatthere are more ports available to connect devices to the host systemcomputer. The network hub 207 may include wired or wireless capabilitiesto receive information over a wired channel or a wireless channel. Inone aspect, a wireless USB short-range, high-bandwidth wireless radiocommunication protocol may be employed for communication between thedevices 1 a-1 n and devices 2 a-2 m located in the operating theater.

In other examples, the operating theater devices 1 a-1 n/2 a-2 m maycommunicate to the modular communication hub 203 via Bluetooth wirelesstechnology standard for exchanging data over short distances (usingshort-wavelength UHF radio waves in the ISM band from 2.4 to 2.485 GHz)from fixed and mobile devices and building personal area networks(PANs). In other aspects, the operating theater devices 1 a-1 n/2 a-2 mmay communicate to the modular communication hub 203 via a number ofwireless or wired communication standards or protocols, including butnot limited to Wi-Fi (IEEE 802.11 family), WiMAX (IEEE 802.16 family),IEEE 802.20, long-term evolution (LTE), and Ev-DO, HSPA+, HSDPA+,HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT, and Ethernet derivativesthereof, as well as any other wireless and wired protocols that aredesignated as 3G, 4G, 5G, and beyond. The computing module may include aplurality of communication modules. For instance, a first communicationmodule may be dedicated to shorter-range wireless communications such asWi-Fi and Bluetooth, and a second communication module may be dedicatedto longer-range wireless communications such as GPS, EDGE, GPRS, CDMA,WiMAX, LTE, Ev-DO, and others.

The modular communication hub 203 may serve as a central connection forone or all of the operating theater devices 1 a-1 n/2 a-2 m and handlesa data type known as frames. Frames carry the data generated by thedevices 1 a-1 n/2 a-2 m. When a frame is received by the modularcommunication hub 203, it is amplified and transmitted to the networkrouter 211, which transfers the data to the cloud computing resources byusing a number of wireless or wired communication standards orprotocols, as described herein.

The modular communication hub 203 can be used as a standalone device orbe connected to compatible network hubs and network switches to form alarger network. The modular communication hub 203 is generally easy toinstall, configure, and maintain, making it a good option for networkingthe operating theater devices 1 a-1 n/2 a-2 m.

FIG. 9 illustrates a computer-implemented interactive surgical system200. The computer-implemented interactive surgical system 200 is similarin many respects to the computer-implemented interactive surgical system100. For example, the computer-implemented interactive surgical system200 includes one or more surgical systems 202, which are similar in manyrespects to the surgical systems 102. Each surgical system 202 includesat least one surgical hub 206 in communication with a cloud 204 that mayinclude a remote server 213. In one aspect, the computer-implementedinteractive surgical system 200 comprises a modular control tower 236connected to multiple operating theater devices such as, for example,intelligent surgical instruments, robots, and other computerized deviceslocated in the operating theater. As shown in FIG. 10 , the modularcontrol tower 236 comprises a modular communication hub 203 coupled to acomputer system 210. As illustrated in the example of FIG. 9 , themodular control tower 236 is coupled to an imaging module 238 that iscoupled to an endoscope 239, a generator module 240 that is coupled toan energy device 241, a smoke evacuation module 226, asuction/irrigation module 228, a communication module 230, a processormodule 232, a storage array 234, a smart device/instrument 235optionally coupled to a display 237, and a non-contact sensor module242. The operating theater devices are coupled to cloud computingresources and data storage via the modular control tower 236. A robothub 222 also may be connected to the modular control tower 236 and tothe cloud computing resources. The devices/instruments 235,visualization system 208, among others, may be coupled to the modularcontrol tower 236 via wired or wireless communication standards orprotocols, as described herein. The modular control tower 236 may becoupled to a surgical hub display 215 (e.g., monitor, screen) to displayand overlay images received from the imaging module, device/instrumentdisplay, and/or other visualization system 208. Surgical hub displayalso may display data received from devices connected to the modularcontrol tower in conjunction with images and overlaid images.

FIG. 10 illustrates a surgical hub 206 comprising a plurality of modulescoupled to the modular control tower 236. The modular control tower 236comprises a modular communication hub 203, e.g., a network connectivitydevice, and a computer system 210 to provide local processing,visualization, and imaging, for example. As shown in FIG. 10 , themodular communication hub 203 may be connected in a tiered configurationto expand the number of modules (e.g., devices) that may be connected tothe modular communication hub 203 and transfer data associated with themodules to the computer system 210, cloud computing resources, or both.As shown in FIG. 10 , each of the network hubs/switches in the modularcommunication hub 203 includes three downstream ports and one upstreamport. The upstream network hub/switch is connected to a processor toprovide a communication connection to the cloud computing resources anda local display 217. Communication to the cloud 204 may be made eitherthrough a wired or a wireless communication channel.

The surgical hub 206 employs a non-contact sensor module 242 to measurethe dimensions of the operating theater and generate a map of thesurgical theater using either ultrasonic or laser-type non-contactmeasurement devices. An ultrasound-based non-contact sensor module scansthe operating theater by transmitting a burst of ultrasound andreceiving the echo when it bounces off the perimeter walls of anoperating theater as described under the heading “Surgical Hub SpatialAwareness Within an Operating Room” in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, which is herein incorporated by reference in itsentirety, in which the sensor module is configured to determine the sizeof the operating theater and to adjust Bluetooth-pairing distancelimits. A laser-based non-contact sensor module scans the operatingtheater by transmitting laser light pulses, receiving laser light pulsesthat bounce off the perimeter walls of the operating theater, andcomparing the phase of the transmitted pulse to the received pulse todetermine the size of the operating theater and to adjust Bluetoothpairing distance limits, for example.

The computer system 210 comprises a processor 244 and a networkinterface 245. The processor 244 is coupled to a communication module247, storage 248, memory 249, non-volatile memory 250, and input/outputinterface 251 via a system bus. The system bus can be any of severaltypes of bus structure(s) including the memory bus or memory controller,a peripheral bus or external bus, and/or a local bus using any varietyof available bus architectures including, but not limited to, 9-bit bus,Industrial Standard Architecture (ISA), Micro-Charmel Architecture(MSA), Extended ISA (EISA), Intelligent Drive Electronics (IDE), VESALocal Bus (VLB), Peripheral Component Interconnect (PCI), USB, AdvancedGraphics Port (AGP), Personal Computer Memory Card InternationalAssociation bus (PCMCIA), Small Computer Systems Interface (SCSI), orany other proprietary bus.

The processor 244 may be any single-core or multicore processor such asthose known under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising anon-chip memory of 256 KB single-cycle flash memory, or othernon-volatile memory, up to 40 MHz, a prefetch buffer to improveperformance above 40 MHz, a 32 KB single-cycle serial random accessmemory (SRAM), an internal read-only memory (ROM) loaded withStellarisWare® software, a 2 KB electrically erasable programmableread-only memory (EEPROM), and/or one or more pulse width modulation(PWM) modules, one or more quadrature encoder inputs (QEI) analogs, oneor more 12-bit analog-to-digital converters (ADCs) with 12 analog inputchannels, details of which are available for the product datasheet.

In one aspect, the processor 244 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The system memory includes volatile memory and non-volatile memory. Thebasic input/output system (BIOS), containing the basic routines totransfer information between elements within the computer system, suchas during start-up, is stored in non-volatile memory. For example, thenon-volatile memory can include ROM, programmable ROM (PROM),electrically programmable ROM (EPROM), EEPROM, or flash memory. Volatilememory includes random-access memory (RAM), which acts as external cachememory. Moreover, RAM is available in many forms such as SRAM, dynamicRAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), and directRambus RAM (DRRAM).

The computer system 210 also includes removable/non-removable,volatile/non-volatile computer storage media, such as for example diskstorage. The disk storage includes, but is not limited to, devices likea magnetic disk drive, floppy disk drive, tape drive, Jaz drive, Zipdrive, LS-60 drive, flash memory card, or memory stick. In addition, thedisk storage can include storage media separately or in combination withother storage media including, but not limited to, an optical disc drivesuch as a compact disc ROM device (CD-ROM), compact disc recordabledrive (CD-R Drive), compact disc rewritable drive (CD-RW Drive), or adigital versatile disc ROM drive (DVD-ROM). To facilitate the connectionof the disk storage devices to the system bus, a removable ornon-removable interface may be employed.

It is to be appreciated that the computer system 210 includes softwarethat acts as an intermediary between users and the basic computerresources described in a suitable operating environment. Such softwareincludes an operating system. The operating system, which can be storedon the disk storage, acts to control and allocate resources of thecomputer system. System applications take advantage of the management ofresources by the operating system through program modules and programdata stored either in the system memory or on the disk storage. It is tobe appreciated that various components described herein can beimplemented with various operating systems or combinations of operatingsystems.

A user enters commands or information into the computer system 210through input device(s) coupled to the I/O interface 251. The inputdevices include, but are not limited to, a pointing device such as amouse, trackball, stylus, touch pad, keyboard, microphone, joystick,game pad, satellite dish, scanner, TV tuner card, digital camera,digital video camera, web camera, and the like. These and other inputdevices connect to the processor through the system bus via interfaceport(s). The interface port(s) include, for example, a serial port, aparallel port, a game port, and a USB. The output device(s) use some ofthe same types of ports as input device(s). Thus, for example, a USBport may be used to provide input to the computer system and to outputinformation from the computer system to an output device. An outputadapter is provided to illustrate that there are some output deviceslike monitors, displays, speakers, and printers, among other outputdevices that require special adapters. The output adapters include, byway of illustration and not limitation, video and sound cards thatprovide a means of connection between the output device and the systembus. It should be noted that other devices and/or systems of devices,such as remote computer(s), provide both input and output capabilities.

The computer system 210 can operate in a networked environment usinglogical connections to one or more remote computers, such as cloudcomputer(s), or local computers. The remote cloud computer(s) can be apersonal computer, server, router, network PC, workstation,microprocessor-based appliance, peer device, or other common networknode, and the like, and typically includes many or all of the elementsdescribed relative to the computer system. For purposes of brevity, onlya memory storage device is illustrated with the remote computer(s). Theremote computer(s) is logically connected to the computer system througha network interface and then physically connected via a communicationconnection. The network interface encompasses communication networkssuch as local area networks (LANs) and wide area networks (WANs). LANtechnologies include Fiber Distributed Data Interface (FDDI), CopperDistributed Data Interface (CDDI), Ethernet/IEEE 802.3, Token Ring/IEEE802.5 and the like. WAN technologies include, but are not limited to,point-to-point links, circuit-switching networks like IntegratedServices Digital Networks (ISDN) and variations thereon,packet-switching networks, and Digital Subscriber Lines (DSL).

In various aspects, the computer system 210 of FIG. 10 , the imagingmodule 238 and/or visualization system 208, and/or the processor module232 of FIGS. 9-10 may comprise an image processor, image processingengine, media processor, or any specialized digital signal processor(DSP) used for the processing of digital images. The image processor mayemploy parallel computing with single instruction, multiple data (SIMD)or multiple instruction, multiple data (MIMD) technologies to increasespeed and efficiency. The digital image processing engine can perform arange of tasks. The image processor may be a system on a chip withmulticore processor architecture.

The communication connection(s) refers to the hardware/software employedto connect the network interface to the bus. While the communicationconnection is shown for illustrative clarity inside the computer system,it can also be external to the computer system 210. Thehardware/software necessary for connection to the network interfaceincludes, for illustrative purposes only, internal and externaltechnologies such as modems, including regular telephone-grade modems,cable modems, and DSL modems, ISDN adapters, and Ethernet cards.

FIG. 11 illustrates a functional block diagram of one aspect of a USBnetwork hub 300 device, according to one aspect of the presentdisclosure. In the illustrated aspect, the USB network hub device 300employs a TUSB2036 integrated circuit hub by Texas Instruments. The USBnetwork hub 300 is a CMOS device that provides an upstream USBtransceiver port 302 and up to three downstream USB transceiver ports304, 306, 308 in compliance with the USB 2.0 specification. The upstreamUSB transceiver port 302 is a differential root data port comprising adifferential data minus (DM0) input paired with a differential data plus(DP0) input. The three downstream USB transceiver ports 304, 306, 308are differential data ports where each port includes differential dataplus (DP1-DP3) outputs paired with differential data minus (DM1-DM3)outputs.

The USB network hub 300 device is implemented with a digital statemachine instead of a microcontroller, and no firmware programming isrequired. Fully compliant USB transceivers are integrated into thecircuit for the upstream USB transceiver port 302 and all downstream USBtransceiver ports 304, 306, 308. The downstream USB transceiver ports304, 306, 308 support both full-speed and low-speed devices byautomatically setting the slew rate according to the speed of the deviceattached to the ports. The USB network hub 300 device may be configuredeither in bus-powered or self-powered mode and includes a surgical hubpower logic 312 to manage power.

The USB network hub 300 device includes a serial interface engine 310(SIE). The SIE 310 is the front end of the USB network hub 300 hardwareand handles most of the protocol described in chapter 8 of the USBspecification. The SIE 310 typically comprehends signaling up to thetransaction level. The functions that it handles could include: packetrecognition, transaction sequencing, SOP, EOP, RESET, and RESUME signaldetection/generation, clock/data separation, non-return-to-zero invert(NRZI) data encoding/decoding and bit-stuffing, CRC generation andchecking (token and data), packet ID (PID) generation andchecking/decoding, and/or serial-parallel/parallel-serial conversion.The STE 310 receives a clock input 314 and is coupled to asuspend/resume logic and frame timer 316 circuit and a surgical hubrepeater circuit 318 to control communication between the upstream USBtransceiver port 302 and the downstream USB transceiver ports 304, 306,308 through port logic circuits 320, 322, 324. The STE 310 is coupled toa command decoder 326 via interface logic to control commands from aserial EEPROM via a serial EEPROM interface 330.

In various aspects, the USB network hub 300 can connect 127 functionsconfigured in up to six logical layers (tiers) to a single computer.Further, the USB network hub 300 can connect to all peripherals using astandardized four-wire cable that provides both communication and powerdistribution. The power configurations are bus-powered and self-poweredmodes. The USB network hub 300 may be configured to support four modesof power management: a bus-powered hub, with either individual-portpower management or ganged-port power management, and the self-poweredhub, with either individual-port power management or ganged-port powermanagement. In one aspect, using a USB cable, the USB network hub 300,the upstream USB transceiver port 302 is plugged into a USB hostcontroller, and the downstream USB transceiver ports 304, 306, 308 areexposed for connecting USB compatible devices, and so forth.

FIG. 12 illustrates a logic diagram of a control system 470 of asurgical instrument or tool in accordance with one or more aspects ofthe present disclosure. The system 470 comprises a control circuit. Thecontrol circuit includes a microcontroller 461 comprising a processor462 and a memory 468. One or more of sensors 472, 474, 476, for example,provide real-time feedback to the processor 462. A motor 482, driven bya motor driver 492, operably couples a longitudinally movabledisplacement member to drive the I-beam knife element. A tracking system480 is configured to determine the position of the longitudinallymovable displacement member. The position information is provided to theprocessor 462, which can be programmed or configured to determine theposition of the longitudinally movable drive member as well as theposition of a firing member, firing bar, and I-beam knife element.Additional motors may be provided at the tool driver interface tocontrol I-beam firing, closure tube travel, shaft rotation, andarticulation. A display 473 displays a variety of operating conditionsof the instruments and may include touch screen functionality for datainput. Information displayed on the display 473 may be overlaid withimages acquired via endoscopic imaging modules.

In one aspect, the microcontroller 461 may be any single-core ormulticore processor such as those known under the trade name ARM Cortexby Texas Instruments. In one aspect, the main microcontroller 461 may bean LM4F230H5QR ARM Cortex-M4F Processor Core, available from TexasInstruments, for example, comprising an on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, and internal ROM loaded with StellarisWare® software,a 2 KB EEPROM, one or more PWM modules, one or more QEI analogs, and/orone or more 12-bit ADCs with 12 analog input channels, details of whichare available for the product datasheet.

In one aspect, the microcontroller 461 may comprise a safety controllercomprising two controller-based families such as TMS570 and RM4x, knownunder the trade name Hercules ARM Cortex R4, also by Texas Instruments.The safety controller may be configured specifically for IEC 61508 andISO 26262 safety critical applications, among others, to provideadvanced integrated safety features while delivering scalableperformance, connectivity, and memory options.

The microcontroller 461 may be programmed to perform various functionssuch as precise control over the speed and position of the knife andarticulation systems. In one aspect, the microcontroller 461 includes aprocessor 462 and a memory 468. The electric motor 482 may be a brusheddirect current (DC) motor with a gearbox and mechanical links to anarticulation or knife system. In one aspect, a motor driver 492 may bean A3941 available from Allegro Microsystems, Inc. Other motor driversmay be readily substituted for use in the tracking system 480 comprisingan absolute positioning system. A detailed description of an absolutepositioning system is described in U.S. Patent Application PublicationNo. 2017/0296213, titled SYSTEMS AND METHODS FOR CONTROLLING A SURGICALSTAPLING AND CUTTING INSTRUMENT, published on Oct. 19, 2017, which isherein incorporated by reference in its entirety.

The microcontroller 461 may be programmed to provide precise controlover the speed and position of displacement members and articulationsystems. The microcontroller 461 may be configured to compute a responsein the software of the microcontroller 461. The computed response iscompared to a measured response of the actual system to obtain an“observed” response, which is used for actual feedback decisions. Theobserved response is a favorable, tuned value that balances the smooth,continuous nature of the simulated response with the measured response,which can detect outside influences on the system.

In one aspect, the motor 482 may be controlled by the motor driver 492and can be employed by the firing system of the surgical instrument ortool. In various forms, the motor 482 may be a brushed DC driving motorhaving a maximum rotational speed of approximately 25,000 RPM. In otherarrangements, the motor 482 may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 492 may comprise an H-bridge drivercomprising field-effect transistors (FETs), for example. The motor 482can be powered by a power assembly releasably mounted to the handleassembly or tool housing for supplying control power to the surgicalinstrument or tool. The power assembly may comprise a battery that mayinclude a number of battery cells connected in series that can be usedas the power source to power the surgical instrument or tool. In certaincircumstances, the battery cells of the power assembly may bereplaceable and/or rechargeable. In at least one example, the batterycells can be lithium-ion batteries which can be couplable to andseparable from the power assembly.

The motor driver 492 may be an A3941 available from AllegroMicrosystems, Inc. The A3941 motor 492 is a full-bridge controller foruse with external N-channel power metal-oxide semiconductor field-effecttransistors (MOSFETs) specifically designed for inductive loads, such asbrush DC motors. The driver 492 comprises a unique charge pump regulatorthat provides full (>10 V) gate drive for battery voltages down to 7 Vand allows the A3941 to operate with a reduced gate drive, down to 5.5V. A bootstrap capacitor may be employed to provide the above batterysupply voltage required for N-channel MOSFETs. An internal charge pumpfor the high-side drive allows DC (100% duty cycle) operation. The fullbridge can be driven in fast or slow decay modes using diode orsynchronous rectification. In the slow decay mode, current recirculationcan be through the high-side or the lowside FETs. The power FETs areprotected from shoot-through by resistor-adjustable dead time.Integrated diagnostics provide indications of undervoltage,overtemperature, and power bridge faults and can be configured toprotect the power MOSFETs undermost short circuit conditions. Othermotor drivers may be readily substituted for use in the tracking system480 comprising an absolute positioning system.

The tracking system 480 comprises a controlled motor drive circuitarrangement comprising a position sensor 472 according to one aspect ofthis disclosure. The position sensor 472 for an absolute positioningsystem provides a unique position signal corresponding to the locationof a displacement member. In one aspect, the displacement memberrepresents a longitudinally movable drive member comprising a rack ofdrive teeth for meshing engagement with a corresponding drive gear of agear reducer assembly. In other aspects, the displacement memberrepresents the firing member, which could be adapted and configured toinclude a rack of drive teeth. In yet another aspect, the displacementmember represents a firing bar or the I-beam, each of which can beadapted and configured to include a rack of drive teeth. Accordingly, asused herein, the term displacement member is used generically to referto any movable member of the surgical instrument or tool such as thedrive member, the firing member, the firing bar, the I-beam, or anyelement that can be displaced. In one aspect, the longitudinally movabledrive member is coupled to the firing member, the firing bar, and theI-beam. Accordingly, the absolute positioning system can, in effect,track the linear displacement of the I-beam by tracking the lineardisplacement of the longitudinally movable drive member. In variousother aspects, the displacement member may be coupled to any positionsensor 472 suitable for measuring linear displacement. Thus, thelongitudinally movable drive member, the firing member, the firing bar,or the I-beam, or combinations thereof, may be coupled to any suitablelinear displacement sensor. Linear displacement sensors may includecontact or non-contact displacement sensors. Linear displacement sensorsmay comprise linear variable differential transformers (LVDT),differential variable reluctance transducers (DVRT), a slidepotentiometer, a magnetic sensing system comprising a movable magnet anda series of linearly arranged Hall-effect sensors, a magnetic sensingsystem comprising a fixed magnet and a series of movable, linearlyarranged Hall-effect sensors, an optical sensing system comprising amovable light source and a series of linearly arranged photo diodes orphoto detectors, an optical sensing system comprising a fixed lightsource and a series of movable linearly, arranged photo diodes or photodetectors, or any combination thereof.

The electric motor 482 can include a rotatable shaft that operablyinterfaces with a gear assembly that is mounted in meshing engagementwith a set, or rack of drive teeth on the displacement member. A sensorelement may be operably coupled to a gear assembly such that a singlerevolution of the position sensor 472 element corresponds to some linearlongitudinal translation of the displacement member. An arrangement ofgearing and sensors can be connected to the linear actuator, via a rackand pinion arrangement, or a rotary actuator, via a spur gear or otherconnection. A power source supplies power to the absolute positioningsystem and an output indicator may display the output of the absolutepositioning system. The displacement member represents thelongitudinally movable drive member comprising a rack of drive teethformed thereon for meshing engagement with a corresponding drive gear ofthe gear reducer assembly. The displacement member represents thelongitudinally movable firing member, firing bar, I-beam, orcombinations thereof.

A single revolution of the sensor element associated with the positionsensor 472 is equivalent to a longitudinal linear displacement d1 of theof the displacement member, where d1 is the longitudinal linear distancethat the displacement member moves from point “a” to point “b” after asingle revolution of the sensor element coupled to the displacementmember. The sensor arrangement may be connected via a gear reductionthat results in the position sensor 472 completing one or morerevolutions for the full stroke of the displacement member. The positionsensor 472 may complete multiple revolutions for the full stroke of thedisplacement member.

A series of switches, where n is an integer greater than one, may beemployed alone or in combination with a gear reduction to provide aunique position signal for more than one revolution of the positionsensor 472. The state of the switches are fed back to themicrocontroller 461 that applies logic to determine a unique positionsignal corresponding to the longitudinal linear displacement d1+d2+ . .. dn of the displacement member. The output of the position sensor 472is provided to the microcontroller 461. The position sensor 472 of thesensor arrangement may comprise a magnetic sensor, an analog rotarysensor like a potentiometer, or an array of analog Hall-effect elements,which output a unique combination of position signals or values.

The position sensor 472 may comprise any number of magnetic sensingelements, such as, for example, magnetic sensors classified according towhether they measure the total magnetic field or the vector componentsof the magnetic field. The techniques used to produce both types ofmagnetic sensors encompass many aspects of physics and electronics. Thetechnologies used for magnetic field sensing include search coil,fluxgate, optically pumped, nuclear precession, SQUID, Hall-effect,anisotropic magnetoresistance, giant magnetoresistance, magnetic tunneljunctions, giant magnetoimpedance, magnetostrictive/piezoelectriccomposites, magnetodiode, magnetotransistor, fiber-optic, magneto-optic,and microelectromechanical systems-based magnetic sensors, among others.

In one aspect, the position sensor 472 for the tracking system 480comprising an absolute positioning system comprises a magnetic rotaryabsolute positioning system. The position sensor 472 may be implementedas an AS5055EQFT single-chip magnetic rotary position sensor availablefrom Austria Microsystems, AG. The position sensor 472 is interfacedwith the microcontroller 461 to provide an absolute positioning system.The position sensor 472 is a low-voltage and low-power component andincludes four Hall-effect elements in an area of the position sensor 472that is located above a magnet. A high-resolution ADC and a smart powermanagement controller are also provided on the chip. A coordinaterotation digital computer (CORDIC) processor, also known as thedigit-by-digit method and Volder's algorithm, is provided to implement asimple and efficient algorithm to calculate hyperbolic and trigonometricfunctions that require only addition, subtraction, bitshift, and tablelookup operations. The angle position, alarm bits, and magnetic fieldinformation are transmitted over a standard serial communicationinterface, such as a serial peripheral interface (SPI) interface, to themicrocontroller 461. The position sensor 472 provides 12 or 14 bits ofresolution. The position sensor 472 may be an AS5055 chip provided in asmall QFN 16-pin 4×4×0.85 mm package.

The tracking system 480 comprising an absolute positioning system maycomprise and/or be programmed to implement a feedback controller, suchas a PID, state feedback, and adaptive controller. A power sourceconverts the signal from the feedback controller into a physical inputto the system: in this case the voltage. Other examples include a PWM ofthe voltage, current, and force. Other sensor(s) may be provided tomeasure physical parameters of the physical system in addition to theposition measured by the position sensor 472. In some aspects, the othersensor(s) can include sensor arrangements such as those described inU.S. Pat. No. 9,345,481, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSORSYSTEM, which issued on May 24, 2016, which is herein incorporated byreference in its entirety; U.S. Patent Application Publication No.2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM,published on Sep. 18, 2014, which is herein incorporated by reference inits entirety; and U.S. patent application Ser. No. 15/628,175, titledTECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICAL STAPLINGAND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is hereinincorporated by reference in its entirety. In a digital signalprocessing system, an absolute positioning system is coupled to adigital data acquisition system where the output of the absolutepositioning system will have a finite resolution and sampling frequency.The absolute positioning system may comprise a compare-and-combinecircuit to combine a computed response with a measured response usingalgorithms, such as a weighted average and a theoretical control loop,that drive the computed response towards the measured response. Thecomputed response of the physical system takes into account propertieslike mass, inertial, viscous friction, inductance resistance, etc., topredict what the states and outputs of the physical system will be byknowing the input.

The absolute positioning system provides an absolute position of thedisplacement member upon power-up of the instrument, without retractingor advancing the displacement member to a reset position (zero or home)as may be required with conventional rotary encoders that merely countthe number of steps forwards or backwards that the motor 482 has takento infer the position of a device actuator, drive bar, knife, or thelike.

A sensor 474, such as, for example, a strain gauge or a micro-straingauge, is configured to measure one or more parameters of the endeffector, such as, for example, the amplitude of the strain exerted onthe anvil during a clamping operation, which can be indicative of theclosure forces applied to the anvil. The measured strain is converted toa digital signal and provided to the processor 462. Alternatively, or inaddition to the sensor 474, a sensor 476, such as, for example, a loadsensor, can measure the closure force applied by the closure drivesystem to the anvil. The sensor 476, such as, for example, a loadsensor, can measure the firing force applied to an I-beam in a firingstroke of the surgical instrument or tool. The I-beam is configured toengage a wedge sled, which is configured to upwardly cam staple driversto force out staples into deforming contact with an anvil. The I-beamalso includes a sharpened cutting edge that can be used to sever tissueas the I-beam is advanced distally by the firing bar. Alternatively, acurrent sensor 478 can be employed to measure the current drawn by themotor 482. The force required to advance the firing member cancorrespond to the current drawn by the motor 482, for example. Themeasured force is converted to a digital signal and provided to theprocessor 462.

In one form, the strain gauge sensor 474 can be used to measure theforce applied to the tissue by the end effector. A strain gauge can becoupled to the end effector to measure the force on the tissue beingtreated by the end effector. A system for measuring forces applied tothe tissue grasped by the end effector comprises a strain gauge sensor474, such as, for example, a micro-strain gauge, that is configured tomeasure one or more parameters of the end effector, for example. In oneaspect, the strain gauge sensor 474 can measure the amplitude ormagnitude of the strain exerted on a jaw member of an end effectorduring a clamping operation, which can be indicative of the tissuecompression. The measured strain is converted to a digital signal andprovided to a processor 462 of the microcontroller 461. A load sensor476 can measure the force used to operate the knife element, forexample, to cut the tissue captured between the anvil and the staplecartridge. A magnetic field sensor can be employed to measure thethickness of the captured tissue. The measurement of the magnetic fieldsensor also may be converted to a digital signal and provided to theprocessor 462.

The measurements of the tissue compression, the tissue thickness, and/orthe force required to close the end effector on the tissue, asrespectively measured by the sensors 474, 476, can be used by themicrocontroller 461 to characterize the selected position of the firingmember and/or the corresponding value of the speed of the firing member.In one instance, a memory 468 may store a technique, an equation, and/ora lookup table which can be employed by the microcontroller 461 in theassessment.

The control system 470 of the surgical instrument or tool also maycomprise wired or wireless communication circuits to communicate withthe modular communication hub as shown in FIGS. 8-11 .

FIG. 13 illustrates a control circuit 500 configured to control aspectsof the surgical instrument or tool according to one aspect of thisdisclosure. The control circuit 500 can be configured to implementvarious processes described herein. The control circuit 500 may comprisea microcontroller comprising one or more processors 502 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit504. The memory circuit 504 stores machine-executable instructions that,when executed by the processor 502, cause the processor 502 to executemachine instructions to implement various processes described herein.The processor 502 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 504 may comprisevolatile and non-volatile storage media. The processor 502 may includean instruction processing unit 506 and an arithmetic unit 508. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 504 of this disclosure.

FIG. 14 illustrates a combinational logic circuit 510 configured tocontrol aspects of the surgical instrument or tool according to oneaspect of this disclosure. The combinational logic circuit 510 can beconfigured to implement various processes described herein. Thecombinational logic circuit 510 may comprise a finite state machinecomprising a combinational logic 512 configured to receive dataassociated with the surgical instrument or tool at an input 514, processthe data by the combinational logic 512, and provide an output 516.

FIG. 15 illustrates a sequential logic circuit 520 configured to controlaspects of the surgical instrument or tool according to one aspect ofthis disclosure. The sequential logic circuit 520 or the combinationallogic 522 can be configured to implement various processes describedherein. The sequential logic circuit 520 may comprise a finite statemachine. The sequential logic circuit 520 may comprise a combinationallogic 522, at least one memory circuit 524, and a clock 529, forexample. The at least one memory circuit 524 can store a current stateof the finite state machine. In certain instances, the sequential logiccircuit 520 may be synchronous or asynchronous. The combinational logic522 is configured to receive data associated with the surgicalinstrument or tool from an input 526, process the data by thecombinational logic 522, and provide an output 528. In other aspects,the circuit may comprise a combination of a processor (e.g., processor502, FIG. 13 ) and a finite state machine to implement various processesherein. In other aspects, the finite state machine may comprise acombination of a combinational logic circuit (e.g., combinational logiccircuit 510, FIG. 14 ) and the sequential logic circuit 520.

FIG. 16 illustrates a surgical instrument or tool comprising a pluralityof motors that can be activated to perform various functions. In certaininstances, a first motor can be activated to perform a first function, asecond motor can be activated to perform a second function, a thirdmotor can be activated to perform a third function, a fourth motor canbe activated to perform a fourth function, and so on. In certaininstances, the plurality of motors of robotic surgical instrument 600can be individually activated to cause firing, closure, and/orarticulation motions in the end effector. The firing, closure, and/orarticulation motions can be transmitted to the end effector through ashaft assembly, for example.

In certain instances, the surgical instrument system or tool may includea firing motor 602. The firing motor 602 may be operably coupled to afiring motor drive assembly 604, which can be configured to transmitfiring motions, generated by the firing motor 602 to the end effector,in particular to displace the I-beam element. In certain instances, thefiring motions generated by the firing motor 602 may cause the staplesto be deployed from the staple cartridge into tissue captured by the endeffector and/or the cutting edge of the I-beam element to be advanced tocut the captured tissue, for example. The I-beam element may beretracted by reversing the direction of the firing motor 602.

In certain instances, the surgical instrument or tool may include aclosure motor 603. The closure motor 603 may be operably coupled to aclosure motor drive assembly 605 which can be configured to transmitclosure motions, generated by the motor 603 to the end effector, inparticular to displace a closure tube to close the anvil and compresstissue between the anvil and the staple cartridge. The closure motionsmay cause the end effector to transition from an open configuration toan approximated configuration to capture tissue, for example. The endeffector may be transitioned to an open position by reversing thedirection of the motor 603.

In certain instances, the surgical instrument or tool may include one ormore articulation motors 606 a, 606 b, for example. The motorsarticulation 606 a, 606 b may be operably coupled to respectivearticulation motor drive assemblies 608 a, 608 b, which can beconfigured to transmit articulation motions generated by thearticulation motors 606 a, 606 b to the end effector. In certaininstances, the articulation motions may cause the end effector toarticulate relative to the shaft, for example.

As described above, the surgical instrument or tool may include aplurality of motors that may be configured to perform variousindependent functions. In certain instances, the plurality of motors ofthe surgical instrument or tool can be individually or separatelyactivated to perform one or more functions while the other motors remaininactive. For example, the articulation motors 606 a, 606 b can beactivated to cause the end effector to be articulated while the firingmotor 602 remains inactive. Alternatively, the firing motor 602 can beactivated to fire the plurality of staples, and/or to advance thecutting edge, while the articulation motor 606 remains inactive.Furthermore the closure motor 603 may be activated simultaneously withthe firing motor 602 to cause the closure tube and the I-beam element toadvance distally as described in more detail hereinbelow.

In certain instances, the surgical instrument or tool may include acommon control module 610, which can be employed with a plurality ofmotors of the surgical instrument or tool. In certain instances, thecommon control module 610 may accommodate one of the plurality of motorsat a time. For example, the common control module 610 can be couplableto and separable from the plurality of motors of the robotic surgicalinstrument individually. In certain instances, a plurality of the motorsof the surgical instrument or tool may share one or more common controlmodules such as the common control module 610. In certain instances, aplurality of motors of the surgical instrument or tool can beindividually and selectively engaged with the common control module 610.In certain instances, the common control module 610 can be selectivelyswitched from interfacing with one of a plurality of motors of thesurgical instrument or tool to interfacing with another one of theplurality of motors of the surgical instrument or tool.

In at least one example, the common control module 610 can beselectively switched between operable engagement with the articulationmotors 606 a, 606 b and operable engagement with either the firing motor602 or the closure motor 603. In at least one example, as illustrated inFIG. 16 , a switch 614 can be moved or transitioned between a pluralityof positions and/or states. In a first position 616, the switch 614 mayelectrically couple the common control module 610 to the firing motor602; in a second position 617, the switch 614 may electrically couplethe common control module 610 to the closure motor 603; in a thirdposition 618 a, the switch 614 may electrically couple the commoncontrol module 610 to the first articulation motor 606 a; and in afourth position 618 b, the switch 614 may electrically couple the commoncontrol module 610 to the second articulation motor 606 b, for example.In certain instances, separate common control modules 610 can beelectrically coupled to the firing motor 602, the closure motor 603, andthe articulation motors 606 a, 606 b at the same time. In certaininstances, the switch 614 may be a mechanical switch, anelectromechanical switch, a solid-state switch, or any suitableswitching mechanism.

Each of the motors 602, 603, 606 a, 606 b may comprise a torque sensorto measure the output torque on the shaft of the motor. The force on anend effector may be sensed in any conventional manner, such as by forcesensors on the outer sides of the jaws or by a torque sensor for themotor actuating the jaws.

In various instances, as illustrated in FIG. 16 , the common controlmodule 610 may comprise a motor driver 626 which may comprise one ormore H-Bridge FETs. The motor driver 626 may modulate the powertransmitted from a power source 628 to a motor coupled to the commoncontrol module 610 based on input from a microcontroller 620 (the“controller”), for example. In certain instances, the microcontroller620 can be employed to determine the current drawn by the motor, forexample, while the motor is coupled to the common control module 610, asdescribed above.

In certain instances, the microcontroller 620 may include amicroprocessor 622 (the “processor”) and one or more non-transitorycomputer-readable mediums or memory units 624 (the “memory”). In certaininstances, the memory 624 may store various program instructions, whichwhen executed may cause the processor 622 to perform a plurality offunctions and/or calculations described herein. In certain instances,one or more of the memory units 624 may be coupled to the processor 622,for example.

In certain instances, the power source 628 can be employed to supplypower to the microcontroller 620, for example. In certain instances, thepower source 628 may comprise a battery (or “battery pack” or “powerpack”), such as a lithium-ion battery, for example. In certaininstances, the battery pack may be configured to be releasably mountedto a handle for supplying power to the surgical instrument 600. A numberof battery cells connected in series may be used as the power source628. In certain instances, the power source 628 may be replaceableand/or rechargeable, for example.

In various instances, the processor 622 may control the motor driver 626to control the position, direction of rotation, and/or velocity of amotor that is coupled to the common control module 610. In certaininstances, the processor 622 can signal the motor driver 626 to stopand/or disable a motor that is coupled to the common control module 610.It should be understood that the term “processor” as used hereinincludes any suitable microprocessor, microcontroller, or other basiccomputing device that incorporates the functions of a computer's centralprocessing unit (CPU) on an integrated circuit or, at most, a fewintegrated circuits. The processor is a multipurpose, programmabledevice that accepts digital data as input, processes it according toinstructions stored in its memory, and provides results as output. It isan example of sequential digital logic, as it has internal memory.Processors operate on numbers and symbols represented in the binarynumeral system.

In one instance, the processor 622 may be any single-core or multicoreprocessor such as those known under the trade name ARM Cortex by TexasInstruments. In certain instances, the microcontroller 620 may be an LM4F230H5QR, available from Texas Instruments, for example. In at leastone example, the Texas Instruments LM4F230H5QR is an ARM Cortex-M4FProcessor Core comprising an on-chip memory of 256 KB single-cycle flashmemory, or other NVM, up to 40 MHz, a prefetch buffer to improveperformance above 40 MHz, a 32 KB single-cycle SRAM, an internal ROMloaded with StellarisWare® software, a 2 KB EEPROM, one or more PWMmodules, one or more QEI analogs, one or more 12-bit ADCs with 12 analoginput channels, among other features that are readily available for theproduct datasheet. Other microcontrollers may be readily substituted foruse with the module 4410. Accordingly, the present disclosure should notbe limited in this context.

In certain instances, the memory 624 may include program instructionsfor controlling each of the motors of the surgical instrument 600 thatare couplable to the common control module 610. For example, the memory624 may include program instructions for controlling the firing motor602, the closure motor 603, and the articulation motors 606 a, 606 b.Such program instructions may cause the processor 622 to control thefiring, closure, and articulation functions in accordance with inputsfrom algorithms or control programs of the surgical instrument or tool.

In certain instances, one or more mechanisms and/or sensors such as, forexample, sensors 630 can be employed to alert the processor 622 to theprogram instructions that should be used in a particular setting. Forexample, the sensors 630 may alert the processor 622 to use the programinstructions associated with firing, closing, and articulating the endeffector. In certain instances, the sensors 630 may comprise positionsensors which can be employed to sense the position of the switch 614,for example. Accordingly, the processor 622 may use the programinstructions associated with firing the I-beam of the end effector upondetecting, through the sensors 630 for example, that the switch 614 isin the first position 616; the processor 622 may use the programinstructions associated with closing the anvil upon detecting, throughthe sensors 630 for example, that the switch 614 is in the secondposition 617; and the processor 622 may use the program instructionsassociated with articulating the end effector upon detecting, throughthe sensors 630 for example, that the switch 614 is in the third orfourth positions 618 a, 618 b.

FIG. 17 is a schematic diagram of a robotic surgical instrument 700configured to operate a surgical tool described herein according to oneaspect of this disclosure. The robotic surgical instrument 700 may beprogrammed or configured to control distal/proximal translation of adisplacement member, distal/proximal displacement of a closure tube,shaft rotation, and articulation, either with single or multiplearticulation drive links. In one aspect, the surgical instrument 700 maybe programmed or configured to individually control a firing member, aclosure member, a shaft member, and/or one or more articulation members.The surgical instrument 700 comprises a control circuit 710 configuredto control motor-driven firing members, closure members, shaft members,and/or one or more articulation members.

In one aspect, the robotic surgical instrument 700 comprises a controlcircuit 710 configured to control an anvil 716 and an I-beam 714(including a sharp cutting edge) portion of an end effector 702, aremovable staple cartridge 718, a shaft 740, and one or morearticulation members 742 a, 742 b via a plurality of motors 704 a-704 e.A position sensor 734 may be configured to provide position feedback ofthe I-beam 714 to the control circuit 710. Other sensors 738 may beconfigured to provide feedback to the control circuit 710. Atimer/counter 731 provides timing and counting information to thecontrol circuit 710. An energy source 712 may be provided to operate themotors 704 a-704 e, and a current sensor 736 provides motor currentfeedback to the control circuit 710. The motors 704 a-704 e can beoperated individually by the control circuit 710 in an open-loop orclosed-loop feedback control.

In one aspect, the control circuit 710 may comprise one or moremicrocontrollers, microprocessors, or other suitable processors forexecuting instructions that cause the processor or processors to performone or more tasks. In one aspect, a timer/counter 731 provides an outputsignal, such as the elapsed time or a digital count, to the controlcircuit 710 to correlate the position of the I-beam 714 as determined bythe position sensor 734 with the output of the timer/counter 731 suchthat the control circuit 710 can determine the position of the I-beam714 at a specific time (t) relative to a starting position or the time(t) when the I-beam 714 is at a specific position relative to a startingposition. The timer/counter 731 may be configured to measure elapsedtime, count external events, or time external events.

In one aspect, the control circuit 710 may be programmed to controlfunctions of the end effector 702 based on one or more tissueconditions. The control circuit 710 may be programmed to sense tissueconditions, such as thickness, either directly or indirectly, asdescribed herein. The control circuit 710 may be programmed to select afiring control program or closure control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 710 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 710 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power. A closure control program may control theclosure force applied to the tissue by the anvil 716. Other controlprograms control the rotation of the shaft 740 and the articulationmembers 742 a, 742 b.

In one aspect, the control circuit 710 may generate motor set pointsignals. The motor set point signals may be provided to various motorcontrollers 708 a-708 e. The motor controllers 708 a-708 e may compriseone or more circuits configured to provide motor drive signals to themotors 704 a-704 e to drive the motors 704 a-704 e as described herein.In some examples, the motors 704 a-704 e may be brushed DC electricmotors. For example, the velocity of the motors 704 a-704 e may beproportional to the respective motor drive signals. In some examples,the motors 704 a-704 e may be brushless DC electric motors, and therespective motor drive signals may comprise a PWM signal provided to oneor more stator windings of the motors 704 a-704 e. Also, in someexamples, the motor controllers 708 a-708 e may be omitted and thecontrol circuit 710 may generate the motor drive signals directly.

In one aspect, the control circuit 710 may initially operate each of themotors 704 a-704 e in an open-loop configuration for a first open-loopportion of a stroke of the displacement member. Based on the response ofthe robotic surgical instrument 700 during the open-loop portion of thestroke, the control circuit 710 may select a firing control program in aclosed-loop configuration. The response of the instrument may include atranslation distance of the displacement member during the open-loopportion, a time elapsed during the open-loop portion, the energyprovided to one of the motors 704 a-704 e during the open-loop portion,a sum of pulse widths of a motor drive signal, etc. After the open-loopportion, the control circuit 710 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during a closed-loop portion of the stroke, the controlcircuit 710 may modulate one of the motors 704 a-704 e based ontranslation data describing a position of the displacement member in aclosed-loop manner to translate the displacement member at a constantvelocity.

In one aspect, the motors 704 a-704 e may receive power from an energysource 712. The energy source 712 may be a DC power supply driven by amain alternating current power source, a battery, a super capacitor, orany other suitable energy source. The motors 704 a-704 e may bemechanically coupled to individual movable mechanical elements such asthe I-beam 714, anvil 716, shaft 740, articulation 742 a, andarticulation 742 b via respective transmissions 706 a-706 e. Thetransmissions 706 a-706 e may include one or more gears or other linkagecomponents to couple the motors 704 a-704 e to movable mechanicalelements. A position sensor 734 may sense a position of the I-beam 714.The position sensor 734 may be or include any type of sensor that iscapable of generating position data that indicate a position of theI-beam 714. In some examples, the position sensor 734 may include anencoder configured to provide a series of pulses to the control circuit710 as the I-beam 714 translates distally and proximally. The controlcircuit 710 may track the pulses to determine the position of the I-beam714. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 714. Also, in someexamples, the position sensor 734 may be omitted. Where any of themotors 704 a-704 e is a stepper motor, the control circuit 710 may trackthe position of the I-beam 714 by aggregating the number and directionof steps that the motor 704 has been instructed to execute. The positionsensor 734 may be located in the end effector 702 or at any otherportion of the instrument. The outputs of each of the motors 704 a-704 einclude a torque sensors 744 a-744 e to sense force and have an encoderto sense rotation of the drive shaft.

In one aspect, the control circuit 710 is configured to drive a firingmember such as the I-beam 714 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 a,which provides a drive signal to the motor 704 a. The output shaft ofthe motor 704 a is coupled to a torque sensor 744 a. The torque sensor744 a is coupled to a transmission 706 a, which is coupled to the I-beam714. The transmission 706 a comprises movable mechanical elements suchas rotating elements and a firing member to control the movement of theI-beam 714 distally and proximally along a longitudinal axis of the endeffector 702. In one aspect, the motor 704 a may be coupled to the knifegear assembly, which includes a knife gear reduction set that includes afirst knife drive gear and a second knife drive gear. A torque sensor744 a provides a firing force feedback signal to the control circuit710. The firing force signal represents the force required to fire ordisplace the I-beam 714. A position sensor 734 may be configured toprovide the position of the I-beam 714 along the firing stroke or theposition of the firing member as a feedback signal to the controlcircuit 710. The end effector 702 may include additional sensors 738configured to provide feedback signals to the control circuit 710. Whenready to use, the control circuit 710 may provide a firing signal to themotor control 708 a. In response to the firing signal, the motor 704 amay drive the firing member distally along the longitudinal axis of theend effector 702 from a proximal stroke start position to a stroke endposition distal to the stroke start position. As the firing membertranslates distally, an I-beam 714, with a cutting element positioned ata distal end, advances distally to cut tissue located between the staplecartridge 718 and the anvil 716.

In one aspect, the control circuit 710 is configured to drive a closuremember such as the anvil 716 portion of the end effector 702. Thecontrol circuit 710 provides a motor set point to a motor control 708 b,which provides a drive signal to the motor 704 b. The output shaft ofthe motor 704 b is coupled to a torque sensor 744 b. The torque sensor744 b is coupled to a transmission 706 b which is coupled to the anvil716. The transmission 706 b comprises movable mechanical elements suchas rotating elements and a closure member to control the movement of theanvil 716 from the open and closed positions. In one aspect, the motor704 b is coupled to a closure gear assembly, which includes a closurereduction gear set that is supported in meshing engagement with theclosure spur gear. The torque sensor 744 b provides a closure forcefeedback signal to the control circuit 710. The closure force feedbacksignal represents the closure force applied to the anvil 716. Theposition sensor 734 may be configured to provide the position of theclosure member as a feedback signal to the control circuit 710.Additional sensors 738 in the end effector 702 may provide the closureforce feedback signal to the control circuit 710. The pivotable anvil716 is positioned opposite the staple cartridge 718. When ready to use,the control circuit 710 may provide a closure signal to the motorcontrol 708 b. In response to the closure signal, the motor 704 badvances a closure member to grasp tissue between the anvil 716 and thestaple cartridge 718.

In one aspect, the control circuit 710 is configured to rotate a shaftmember such as the shaft 740 to rotate the end effector 702. The controlcircuit 710 provides a motor set point to a motor control 708 c, whichprovides a drive signal to the motor 704 c. The output shaft of themotor 704 c is coupled to a torque sensor 744 c. The torque sensor 744 cis coupled to a transmission 706 c, which is coupled to the shaft 740.The transmission 706 c comprises movable mechanical elements such asrotating elements to control the rotation of the shaft 740 clockwise orcounterclockwise up to and over 360°. In one aspect, the motor 704 c iscoupled to the rotational transmission assembly, which includes a tubegear segment that is formed on (or attached to) the proximal end of theproximal closure tube for operable engagement by a rotational gearassembly that is operably supported on the tool mounting plate. Thetorque sensor 744 c provides a rotation force feedback signal to thecontrol circuit 710. The rotation force feedback signal represents therotation force applied to the shaft 740. The position sensor 734 may beconfigured to provide the position of the closure member as a feedbacksignal to the control circuit 710. Additional sensors 738 such as ashaft encoder may provide the rotational position of the shaft 740 tothe control circuit 710.

In one aspect, the control circuit 710 is configured to articulate theend effector 702. The control circuit 710 provides a motor set point toa motor control 708 d, which provides a drive signal to the motor 704 d.The output shaft of the motor 704 d is coupled to a torque sensor 744 d.The torque sensor 744 d is coupled to a transmission 706 d, which iscoupled to an articulation member 742 a. The transmission 706 dcomprises movable mechanical elements such as articulation elements tocontrol the articulation of the end effector 702±65°. In one aspect, themotor 704 d is coupled to an articulation nut, which is rotatablyjournaled on the proximal end portion of the distal spine portion and isrotatably driven thereon by an articulation gear assembly. The torquesensor 744 d provides an articulation force feedback signal to thecontrol circuit 710. The articulation force feedback signal representsthe articulation force applied to the end effector 702. Sensors 738,such as an articulation encoder, may provide the articulation positionof the end effector 702 to the control circuit 710.

In another aspect, the articulation function of the robotic surgicalsystem 700 may comprise two articulation members, or links, 742 a, 742b. These articulation members 742 a, 742 b are driven by separate diskson the robot interface (the rack), which are driven by the two motors704 d, 704 e. When the separate firing motor 704 a is provided, each ofarticulation links 742 a, 742 b can be antagonistically driven withrespect to the other link in order to provide a resistive holding motionand a load to the head when it is not moving and to provide anarticulation motion as the head is articulated. The articulation members742 a, 742 b attach to the head at a fixed radius as the head isrotated. Accordingly, the mechanical advantage of the push-and-pull linkchanges as the head is rotated. This change in the mechanical advantagemay be more pronounced with other articulation link drive systems.

In one aspect, the one or more motors 704 a-704 e may comprise a brushedDC motor with a gearbox and mechanical links to a firing member, closuremember, or articulation member. Another example includes electric motors704 a-704 e that operate the movable mechanical elements such as thedisplacement member, articulation links, closure tube, and shaft. Anoutside influence is an unmeasured, unpredictable influence of thingslike tissue, surrounding bodies, and friction on the physical system.Such outside influence can be referred to as drag, which acts inopposition to one of electric motors 704 a-704 e. The outside influence,such as drag, may cause the operation of the physical system to deviatefrom a desired operation of the physical system.

In one aspect, the position sensor 734 may be implemented as an absolutepositioning system. In one aspect, the position sensor 734 may comprisea magnetic rotary absolute positioning system implemented as anAS5055EQFT single-chip magnetic rotary position sensor available fromAustria Microsystems, AG. The position sensor 734 may interface with thecontrol circuit 710 to provide an absolute positioning system. Theposition may include multiple Hall-effect elements located above amagnet and coupled to a CORDIC processor, also known as thedigit-by-digit method and Volder's algorithm, that is provided toimplement a simple and efficient algorithm to calculate hyperbolic andtrigonometric functions that require only addition, subtraction,bitshift, and table lookup operations.

In one aspect, the control circuit 710 may be in communication with oneor more sensors 738. The sensors 738 may be positioned on the endeffector 702 and adapted to operate with the robotic surgical instrument700 to measure the various derived parameters such as the gap distanceversus time, tissue compression versus time, and anvil strain versustime. The sensors 738 may comprise a magnetic sensor, a magnetic fieldsensor, a strain gauge, a load cell, a pressure sensor, a force sensor,a torque sensor, an inductive sensor such as an eddy current sensor, aresistive sensor, a capacitive sensor, an optical sensor, and/or anyother suitable sensor for measuring one or more parameters of the endeffector 702. The sensors 738 may include one or more sensors. Thesensors 738 may be located on the staple cartridge 718 deck to determinetissue location using segmented electrodes. The torque sensors 744 a-744e may be configured to sense force such as firing force, closure force,and/or articulation force, among others. Accordingly, the controlcircuit 710 can sense (1) the closure load experienced by the distalclosure tube and its position, (2) the firing member at the rack and itsposition, (3) what portion of the staple cartridge 718 has tissue on it,and (4) the load and position on both articulation rods.

In one aspect, the one or more sensors 738 may comprise a strain gauge,such as a micro-strain gauge, configured to measure the magnitude of thestrain in the anvil 716 during a clamped condition. The strain gaugeprovides an electrical signal whose amplitude varies with the magnitudeof the strain. The sensors 738 may comprise a pressure sensor configuredto detect a pressure generated by the presence of compressed tissuebetween the anvil 716 and the staple cartridge 718. The sensors 738 maybe configured to detect impedance of a tissue section located betweenthe anvil 716 and the staple cartridge 718 that is indicative of thethickness and/or fullness of tissue located therebetween.

In one aspect, the sensors 738 may be implemented as one or more limitswitches, electromechanical devices, solid-state switches, Hall-effectdevices, magneto-resistive (MR) devices, giant magneto-resistive (GMR)devices, magnetometers, among others. In other implementations, thesensors 738 may be implemented as solid-state switches that operateunder the influence of light, such as optical sensors, IR sensors,ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors738 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the sensors 738 may be configured to measure forcesexerted on the anvil 716 by the closure drive system. For example, oneor more sensors 738 can be at an interaction point between the closuretube and the anvil 716 to detect the closure forces applied by theclosure tube to the anvil 716. The forces exerted on the anvil 716 canbe representative of the tissue compression experienced by the tissuesection captured between the anvil 716 and the staple cartridge 718. Theone or more sensors 738 can be positioned at various interaction pointsalong the closure drive system to detect the closure forces applied tothe anvil 716 by the closure drive system. The one or more sensors 738may be sampled in real time during a clamping operation by the processorof the control circuit 710. The control circuit 710 receives real-timesample measurements to provide and analyze time-based information andassess, in real time, closure forces applied to the anvil 716.

In one aspect, a current sensor 736 can be employed to measure thecurrent drawn by each of the motors 704 a-704 e. The force required toadvance any of the movable mechanical elements such as the I-beam 714corresponds to the current drawn by one of the motors 704 a-704 e. Theforce is converted to a digital signal and provided to the controlcircuit 710. The control circuit 710 can be configured to simulate theresponse of the actual system of the instrument in the software of thecontroller. A displacement member can be actuated to move an I-beam 714in the end effector 702 at or near a target velocity. The roboticsurgical instrument 700 can include a feedback controller, which can beone of any feedback controllers, including, but not limited to a PID, astate feedback, a linear-quadratic (LQR), and/or an adaptive controller,for example. The robotic surgical instrument 700 can include a powersource to convert the signal from the feedback controller into aphysical input such as case voltage, PWM voltage, frequency modulatedvoltage, current, torque, and/or force, for example. Additional detailsare disclosed in U.S. patent application Ser. No. 15/636,829, titledCLOSED LOOP VELOCITY CONTROL TECHNIQUES FOR ROBOTIC SURGICAL INSTRUMENT,filed Jun. 29, 2017, which is herein incorporated by reference in itsentirety.

FIG. 18 illustrates a block diagram of a surgical instrument 750programmed to control the distal translation of a displacement memberaccording to one aspect of this disclosure. In one aspect, the surgicalinstrument 750 is programmed to control the distal translation of adisplacement member such as the I-beam 764. The surgical instrument 750comprises an end effector 752 that may comprise an anvil 766, an I-beam764 (including a sharp cutting edge), and a removable staple cartridge768.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensor784. Because the I-beam 764 is coupled to a longitudinally movable drivemember, the position of the I-beam 764 can be determined by measuringthe position of the longitudinally movable drive member employing theposition sensor 784. Accordingly, in the following description, theposition, displacement, and/or translation of the I-beam 764 can beachieved by the position sensor 784 as described herein. A controlcircuit 760 may be programmed to control the translation of thedisplacement member, such as the I-beam 764. The control circuit 760, insome examples, may comprise one or more microcontrollers,microprocessors, or other suitable processors for executing instructionsthat cause the processor or processors to control the displacementmember, e.g., the I-beam 764, in the manner described. In one aspect, atimer/counter 781 provides an output signal, such as the elapsed time ora digital count, to the control circuit 760 to correlate the position ofthe I-beam 764 as determined by the position sensor 784 with the outputof the timer/counter 781 such that the control circuit 760 can determinethe position of the I-beam 764 at a specific time (t) relative to astarting position. The timer/counter 781 may be configured to measureelapsed time, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of theI-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor 754 has been instructed to execute. The position sensor 784 may belocated in the end effector 752 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 752 andadapted to operate with the surgical instrument 750 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 752. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be configured to measure forces exerted on the anvil766 by a closure drive system. For example, one or more sensors 788 canbe at an interaction point between a closure tube and the anvil 766 todetect the closure forces applied by a closure tube to the anvil 766.The forces exerted on the anvil 766 can be representative of the tissuecompression experienced by the tissue section captured between the anvil766 and the staple cartridge 768. The one or more sensors 788 can bepositioned at various interaction points along the closure drive systemto detect the closure forces applied to the anvil 766 by the closuredrive system. The one or more sensors 788 may be sampled in real timeduring a clamping operation by a processor of the control circuit 760.The control circuit 760 receives real-time sample measurements toprovide and analyze time-based information and assess, in real time,closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

The control circuit 760 can be configured to simulate the response ofthe actual system of the instrument in the software of the controller. Adisplacement member can be actuated to move an I-beam 764 in the endeffector 752 at or near a target velocity. The surgical instrument 750can include a feedback controller, which can be one of any feedbackcontrollers, including, but not limited to a PID, a state feedback, anLQR, and/or an adaptive controller, for example. The surgical instrument750 can include a power source to convert the signal from the feedbackcontroller into a physical input such as case voltage, PWM voltage,frequency modulated voltage, current, torque, and/or force, for example.

The actual drive system of the surgical instrument 750 is configured todrive the displacement member, cutting member, or I-beam 764, by abrushed DC motor with gearbox and mechanical links to an articulationand/or knife system. Another example is the electric motor 754 thatoperates the displacement member and the articulation driver, forexample, of an interchangeable shaft assembly. An outside influence isan unmeasured, unpredictable influence of things like tissue,surrounding bodies, and friction on the physical system. Such outsideinfluence can be referred to as drag which acts in opposition to theelectric motor 754. The outside influence, such as drag, may cause theoperation of the physical system to deviate from a desired operation ofthe physical system.

Various example aspects are directed to a surgical instrument 750comprising an end effector 752 with motor-driven surgical stapling andcutting implements. For example, a motor 754 may drive a displacementmember distally and proximally along a longitudinal axis of the endeffector 752. The end effector 752 may comprise a pivotable anvil 766and, when configured for use, a staple cartridge 768 positioned oppositethe anvil 766. A clinician may grasp tissue between the anvil 766 andthe staple cartridge 768, as described herein. When ready to use theinstrument 750, the clinician may provide a firing signal, for exampleby depressing a trigger of the instrument 750. In response to the firingsignal, the motor 754 may drive the displacement member distally alongthe longitudinal axis of the end effector 752 from a proximal strokebegin position to a stroke end position distal of the stroke beginposition. As the displacement member translates distally, an I-beam 764with a cutting element positioned at a distal end, may cut the tissuebetween the staple cartridge 768 and the anvil 766.

In various examples, the surgical instrument 750 may comprise a controlcircuit 760 programmed to control the distal translation of thedisplacement member, such as the I-beam 764, for example, based on oneor more tissue conditions. The control circuit 760 may be programmed tosense tissue conditions, such as thickness, either directly orindirectly, as described herein. The control circuit 760 may beprogrammed to select a firing control program based on tissueconditions. A firing control program may describe the distal motion ofthe displacement member. Different firing control programs may beselected to better treat different tissue conditions. For example, whenthicker tissue is present, the control circuit 760 may be programmed totranslate the displacement member at a lower velocity and/or with lowerpower. When thinner tissue is present, the control circuit 760 may beprogrammed to translate the displacement member at a higher velocityand/or with higher power.

In some examples, the control circuit 760 may initially operate themotor 754 in an open loop configuration for a first open loop portion ofa stroke of the displacement member. Based on a response of theinstrument 750 during the open loop portion of the stroke, the controlcircuit 760 may select a firing control program. The response of theinstrument may include, a translation distance of the displacementmember during the open loop portion, a time elapsed during the open loopportion, energy provided to the motor 754 during the open loop portion,a sum of pulse widths of a motor drive signal, etc. After the open loopportion, the control circuit 760 may implement the selected firingcontrol program for a second portion of the displacement member stroke.For example, during the closed loop portion of the stroke, the controlcircuit 760 may modulate the motor 754 based on translation datadescribing a position of the displacement member in a closed loop mannerto translate the displacement member at a constant velocity. Additionaldetails are disclosed in U.S. patent application Ser. No. 15/720,852,titled SYSTEM AND METHODS FOR CONTROLLING A DISPLAY OF A SURGICALINSTRUMENT, filed Sep. 29, 2017, which is herein incorporated byreference in its entirety.

FIG. 19 is a schematic diagram of a surgical instrument 790 configuredto control various functions according to one aspect of this disclosure.In one aspect, the surgical instrument 790 is programmed to controldistal translation of a displacement member such as the I-beam 764. Thesurgical instrument 790 comprises an end effector 792 that may comprisean anvil 766, an I-beam 764, and a removable staple cartridge 768, whichmay be interchanged with an RF cartridge 796 (shown in dashed line).

In one aspect, sensors 788 may be implemented as a limit switch,electromechanical device, solid-state switches, Hall-effect devices, MRdevices, GMR devices, magnetometers, among others. In otherimplementations, the sensors 638 may be solid-state switches thatoperate under the influence of light, such as optical sensors, IRsensors, ultraviolet sensors, among others. Still, the switches may besolid-state devices such as transistors (e.g., FET, junction FET,MOSFET, bipolar, and the like). In other implementations, the sensors788 may include electrical conductorless switches, ultrasonic switches,accelerometers, and inertial sensors, among others.

In one aspect, the position sensor 784 may be implemented as an absolutepositioning system comprising a magnetic rotary absolute positioningsystem implemented as an AS5055EQFT single-chip magnetic rotary positionsensor available from Austria Microsystems, AG. The position sensor 784may interface with the control circuit 760 to provide an absolutepositioning system. The position may include multiple Hall-effectelements located above a magnet and coupled to a CORDIC processor, alsoknown as the digit-by-digit method and Volder's algorithm, that isprovided to implement a simple and efficient algorithm to calculatehyperbolic and trigonometric functions that require only addition,subtraction, bitshift, and table lookup operations.

In one aspect, the I-beam 764 may be implemented as a knife membercomprising a knife body that operably supports a tissue cutting bladethereon and may further include anvil engagement tabs or features andchannel engagement features or a foot. In one aspect, the staplecartridge 768 may be implemented as a standard (mechanical) surgicalfastener cartridge. In one aspect, the RF cartridge 796 may beimplemented as an RF cartridge. These and other sensors arrangements aredescribed in commonly owned U.S. patent application Ser. No. 15/628,175,titled TECHNIQUES FOR ADAPTIVE CONTROL OF MOTOR VELOCITY OF A SURGICALSTAPLING AND CUTTING INSTRUMENT, filed Jun. 20, 2017, which is hereinincorporated by reference in its entirety.

The position, movement, displacement, and/or translation of a lineardisplacement member, such as the I-beam 764, can be measured by anabsolute positioning system, sensor arrangement, and position sensorrepresented as position sensor 784. Because the I-beam 764 is coupled tothe longitudinally movable drive member, the position of the I-beam 764can be determined by measuring the position of the longitudinallymovable drive member employing the position sensor 784. Accordingly, inthe following description, the position, displacement, and/ortranslation of the I-beam 764 can be achieved by the position sensor 784as described herein. A control circuit 760 may be programmed to controlthe translation of the displacement member, such as the I-beam 764, asdescribed herein. The control circuit 760, in some examples, maycomprise one or more microcontrollers, microprocessors, or othersuitable processors for executing instructions that cause the processoror processors to control the displacement member, e.g., the I-beam 764,in the manner described. In one aspect, a timer/counter 781 provides anoutput signal, such as the elapsed time or a digital count, to thecontrol circuit 760 to correlate the position of the I-beam 764 asdetermined by the position sensor 784 with the output of thetimer/counter 781 such that the control circuit 760 can determine theposition of the I-beam 764 at a specific time (t) relative to a startingposition. The timer/counter 781 may be configured to measure elapsedtime, count external events, or time external events.

The control circuit 760 may generate a motor set point signal 772. Themotor set point signal 772 may be provided to a motor controller 758.The motor controller 758 may comprise one or more circuits configured toprovide a motor drive signal 774 to the motor 754 to drive the motor 754as described herein. In some examples, the motor 754 may be a brushed DCelectric motor. For example, the velocity of the motor 754 may beproportional to the motor drive signal 774. In some examples, the motor754 may be a brushless DC electric motor and the motor drive signal 774may comprise a PWM signal provided to one or more stator windings of themotor 754. Also, in some examples, the motor controller 758 may beomitted, and the control circuit 760 may generate the motor drive signal774 directly.

The motor 754 may receive power from an energy source 762. The energysource 762 may be or include a battery, a super capacitor, or any othersuitable energy source. The motor 754 may be mechanically coupled to theI-beam 764 via a transmission 756. The transmission 756 may include oneor more gears or other linkage components to couple the motor 754 to theI-beam 764. A position sensor 784 may sense a position of the I-beam764. The position sensor 784 may be or include any type of sensor thatis capable of generating position data that indicate a position of theI-beam 764. In some examples, the position sensor 784 may include anencoder configured to provide a series of pulses to the control circuit760 as the I-beam 764 translates distally and proximally. The controlcircuit 760 may track the pulses to determine the position of the I-beam764. Other suitable position sensors may be used, including, forexample, a proximity sensor. Other types of position sensors may provideother signals indicating motion of the I-beam 764. Also, in someexamples, the position sensor 784 may be omitted. Where the motor 754 isa stepper motor, the control circuit 760 may track the position of theI-beam 764 by aggregating the number and direction of steps that themotor has been instructed to execute. The position sensor 784 may belocated in the end effector 792 or at any other portion of theinstrument.

The control circuit 760 may be in communication with one or more sensors788. The sensors 788 may be positioned on the end effector 792 andadapted to operate with the surgical instrument 790 to measure thevarious derived parameters such as gap distance versus time, tissuecompression versus time, and anvil strain versus time. The sensors 788may comprise a magnetic sensor, a magnetic field sensor, a strain gauge,a pressure sensor, a force sensor, an inductive sensor such as an eddycurrent sensor, a resistive sensor, a capacitive sensor, an opticalsensor, and/or any other suitable sensor for measuring one or moreparameters of the end effector 792. The sensors 788 may include one ormore sensors.

The one or more sensors 788 may comprise a strain gauge, such as amicro-strain gauge, configured to measure the magnitude of the strain inthe anvil 766 during a clamped condition. The strain gauge provides anelectrical signal whose amplitude varies with the magnitude of thestrain. The sensors 788 may comprise a pressure sensor configured todetect a pressure generated by the presence of compressed tissue betweenthe anvil 766 and the staple cartridge 768. The sensors 788 may beconfigured to detect impedance of a tissue section located between theanvil 766 and the staple cartridge 768 that is indicative of thethickness and/or fullness of tissue located therebetween.

The sensors 788 may be configured to measure forces exerted on the anvil766 by the closure drive system. For example, one or more sensors 788can be at an interaction point between a closure tube and the anvil 766to detect the closure forces applied by a closure tube to the anvil 766.The forces exerted on the anvil 766 can be representative of the tissuecompression experienced by the tissue section captured between the anvil766 and the staple cartridge 768. The one or more sensors 788 can bepositioned at various interaction points along the closure drive systemto detect the closure forces applied to the anvil 766 by the closuredrive system. The one or more sensors 788 may be sampled in real timeduring a clamping operation by a processor portion of the controlcircuit 760. The control circuit 760 receives real-time samplemeasurements to provide and analyze time-based information and assess,in real time, closure forces applied to the anvil 766.

A current sensor 786 can be employed to measure the current drawn by themotor 754. The force required to advance the I-beam 764 corresponds tothe current drawn by the motor 754. The force is converted to a digitalsignal and provided to the control circuit 760.

An RF energy source 794 is coupled to the end effector 792 and isapplied to the RF cartridge 796 when the RF cartridge 796 is loaded inthe end effector 792 in place of the staple cartridge 768. The controlcircuit 760 controls the delivery of the RF energy to the RF cartridge796.

Additional details are disclosed in U.S. patent application Ser. No.15/636,096, titled SURGICAL SYSTEM COUPLABLE WITH STAPLE CARTRIDGE ANDRADIO FREQUENCY CARTRIDGE, AND METHOD OF USING SAME, filed Jun. 28,2017, which is herein incorporated by reference in its entirety.

FIG. 20 is a simplified block diagram of a generator 800 configured toprovide inductorless tuning, among other benefits. Additional details ofthe generator 800 are described in U.S. Pat. No. 9,060,775, titledSURGICAL GENERATOR FOR ULTRASONIC AND ELECTROSURGICAL DEVICES, whichissued on Jun. 23, 2015, which is herein incorporated by reference inits entirety. The generator 800 may comprise a patient isolated stage802 in communication with a non-isolated stage 804 via a powertransformer 806. A secondary winding 808 of the power transformer 806 iscontained in the isolated stage 802 and may comprise a tappedconfiguration (e.g., a center-tapped or a non-center-tappedconfiguration) to define drive signal outputs 810 a, 810 b, 810 c fordelivering drive signals to different surgical instruments, such as, forexample, an ultrasonic surgical instrument, an RF electrosurgicalinstrument, and a multifunction surgical instrument, which includesultrasonic and RF energy modes that can be delivered alone orsimultaneously. In particular, drive signal outputs 810 a, 810 c mayoutput an ultrasonic drive signal (e.g., a 420V root-mean-square (RMS)drive signal) to an ultrasonic surgical instrument, and drive signaloutputs 810 b, 810 c may output an RF electrosurgical drive signal(e.g., a 100V RMS drive signal) to an RF electrosurgical instrument,with the drive signal output 810 b corresponding to the center tap ofthe power transformer 806.

In certain forms, the ultrasonic and electrosurgical drive signals maybe provided simultaneously to distinct surgical instruments and/or to asingle surgical instrument, such as the multifunction surgicalinstrument, having the capability to deliver both ultrasonic andelectrosurgical energy to tissue. It will be appreciated that theelectrosurgical signal, provided either to a dedicated electrosurgicalinstrument and/or to a combined multifunction ultrasonic/electrosurgicalinstrument may be either a therapeutic or sub-therapeutic level signalwhere the sub-therapeutic signal can be used, for example, to monitortissue or instrument conditions and provide feedback to the generator.For example, the ultrasonic and RF signals can be delivered separatelyor simultaneously from a generator with a single output port in order toprovide the desired output signal to the surgical instrument, as will bediscussed in more detail below. Accordingly, the generator can combinethe ultrasonic and electrosurgical RF energies and deliver the combinedenergies to the multifunction ultrasonic/electrosurgical instrument.Bipolar electrodes can be placed on one or both jaws of the endeffector. One jaw may be driven by ultrasonic energy in addition toelectrosurgical RF energy, working simultaneously. The ultrasonic energymay be employed to dissect tissue, while the electrosurgical RF energymay be employed for vessel sealing.

The non-isolated stage 804 may comprise a power amplifier 812 having anoutput connected to a primary winding 814 of the power transformer 806.In certain forms, the power amplifier 812 may comprise a push-pullamplifier. For example, the non-isolated stage 804 may further comprisea logic device 816 for supplying a digital output to a digital-to-analogconverter (DAC) circuit 818, which in turn supplies a correspondinganalog signal to an input of the power amplifier 812. In certain forms,the logic device 816 may comprise a programmable gate array (PGA), afield programmable gate array (FPGA), programmable logic device (PLD),among other logic circuits, for example. The logic device 816, by virtueof controlling the input of the power amplifier 812 via the DAC circuit818, may therefore control any of a number of parameters (e.g.,frequency, waveform shape, waveform amplitude) of drive signalsappearing at the drive signal outputs 810 a, 810 b, 810 c. In certainforms and as discussed below, the logic device 816, in conjunction witha processor (e.g., a DSP discussed below), may implement a number ofDSP-based and/or other control algorithms to control parameters of thedrive signals output by the generator 800.

Power may be supplied to a power rail of the power amplifier 812 by aswitch-mode regulator 820, e.g., a power converter. In certain forms,the switch-mode regulator 820 may comprise an adjustable buck regulator,for example. The non-isolated stage 804 may further comprise a firstprocessor 822, which in one form may comprise a DSP processor such as anAnalog Devices ADSP-21469 SHARC DSP, available from Analog Devices,Norwood, MA, for example, although in various forms any suitableprocessor may be employed. In certain forms the DSP processor 822 maycontrol the operation of the switch-mode regulator 820 responsive tovoltage feedback data received from the power amplifier 812 by the DSPprocessor 822 via an ADC circuit 824. In one form, for example, the DSPprocessor 822 may receive as input, via the ADC circuit 824, thewaveform envelope of a signal (e.g., an RF signal) being amplified bythe power amplifier 812. The DSP processor 822 may then control theswitch-mode regulator 820 (e.g., via a PWM output) such that the railvoltage supplied to the power amplifier 812 tracks the waveform envelopeof the amplified signal. By dynamically modulating the rail voltage ofthe power amplifier 812 based on the waveform envelope, the efficiencyof the power amplifier 812 may be significantly improved relative to afixed rail voltage amplifier schemes.

In certain forms, the logic device 816, in conjunction with the DSPprocessor 822, may implement a digital synthesis circuit such as adirect digital synthesizer control scheme to control the waveform shape,frequency, and/or amplitude of drive signals output by the generator800. In one form, for example, the logic device 816 may implement a DDScontrol algorithm by recalling waveform samples stored in a dynamicallyupdated lookup table (LUT), such as a RAM LUT, which may be embedded inan FPGA. This control algorithm is particularly useful for ultrasonicapplications in which an ultrasonic transducer, such as an ultrasonictransducer, may be driven by a clean sinusoidal current at its resonantfrequency. Because other frequencies may excite parasitic resonances,minimizing or reducing the total distortion of the motional branchcurrent may correspondingly minimize or reduce undesirable resonanceeffects. Because the waveform shape of a drive signal output by thegenerator 800 is impacted by various sources of distortion present inthe output drive circuit (e.g., the power transformer 806, the poweramplifier 812), voltage and current feedback data based on the drivesignal may be input into an algorithm, such as an error controlalgorithm implemented by the DSP processor 822, which compensates fordistortion by suitably pre-distorting or modifying the waveform samplesstored in the LUT on a dynamic, ongoing basis (e.g., in real time). Inone form, the amount or degree of pre-distortion applied to the LUTsamples may be based on the error between a computed motional branchcurrent and a desired current waveform shape, with the error beingdetermined on a sample-by-sample basis. In this way, the pre-distortedLUT samples, when processed through the drive circuit, may result in amotional branch drive signal having the desired waveform shape (e.g.,sinusoidal) for optimally driving the ultrasonic transducer. In suchforms, the LUT waveform samples will therefore not represent the desiredwaveform shape of the drive signal, but rather the waveform shape thatis required to ultimately produce the desired waveform shape of themotional branch drive signal when distortion effects are taken intoaccount.

The non-isolated stage 804 may further comprise a first ADC circuit 826and a second ADC circuit 828 coupled to the output of the powertransformer 806 via respective isolation transformers 830, 832 forrespectively sampling the voltage and current of drive signals output bythe generator 800. In certain forms, the ADC circuits 826, 828 may beconfigured to sample at high speeds (e.g., 80 mega samples per second(MSPS)) to enable oversampling of the drive signals. In one form, forexample, the sampling speed of the ADC circuits 826, 828 may enableapproximately 200× (depending on frequency) oversampling of the drivesignals. In certain forms, the sampling operations of the ADC circuit826, 828 may be performed by a single ADC circuit receiving inputvoltage and current signals via a two-way multiplexer. The use ofhigh-speed sampling in forms of the generator 800 may enable, amongother things, calculation of the complex current flowing through themotional branch (which may be used in certain forms to implementDDS-based waveform shape control described above), accurate digitalfiltering of the sampled signals, and calculation of real powerconsumption with a high degree of precision. Voltage and currentfeedback data output by the ADC circuits 826, 828 may be received andprocessed (e.g., first-in-first-out (FIFO) buffer, multiplexer) by thelogic device 816 and stored in data memory for subsequent retrieval by,for example, the DSP processor 822. As noted above, voltage and currentfeedback data may be used as input to an algorithm for pre-distorting ormodifying LUT waveform samples on a dynamic and ongoing basis. Incertain forms, this may require each stored voltage and current feedbackdata pair to be indexed based on, or otherwise associated with, acorresponding LUT sample that was output by the logic device 816 whenthe voltage and current feedback data pair was acquired. Synchronizationof the LUT samples and the voltage and current feedback data in thismanner contributes to the correct timing and stability of thepre-distortion algorithm.

In certain forms, the voltage and current feedback data may be used tocontrol the frequency and/or amplitude (e.g., current amplitude) of thedrive signals. In one form, for example, voltage and current feedbackdata may be used to determine impedance phase. The frequency of thedrive signal may then be controlled to minimize or reduce the differencebetween the determined impedance phase and an impedance phase setpoint(e.g., 00), thereby minimizing or reducing the effects of harmonicdistortion and correspondingly enhancing impedance phase measurementaccuracy. The determination of phase impedance and a frequency controlsignal may be implemented in the DSP processor 822, for example, withthe frequency control signal being supplied as input to a DDS controlalgorithm implemented by the logic device 816.

In another form, for example, the current feedback data may be monitoredin order to maintain the current amplitude of the drive signal at acurrent amplitude setpoint. The current amplitude setpoint may bespecified directly or determined indirectly based on specified voltageamplitude and power setpoints. In certain forms, control of the currentamplitude may be implemented by control algorithm, such as, for example,a proportional-integral-derivative (PID) control algorithm, in the DSPprocessor 822. Variables controlled by the control algorithm to suitablycontrol the current amplitude of the drive signal may include, forexample, the scaling of the LUT waveform samples stored in the logicdevice 816 and/or the full-scale output voltage of the DAC circuit 818(which supplies the input to the power amplifier 812) via a DAC circuit834.

The non-isolated stage 804 may further comprise a second processor 836for providing, among other things user interface (UI) functionality. Inone form, the UI processor 836 may comprise an Atmel AT91SAM9263processor having an ARM 926EJ-S core, available from Atmel Corporation,San Jose, California, for example. Examples of UI functionalitysupported by the UI processor 836 may include audible and visual userfeedback, communication with peripheral devices (e.g., via a USBinterface), communication with a foot switch, communication with aninput device (e.g., a touch screen display), and communication with anoutput device (e.g., a speaker). The UI processor 836 may communicatewith the DSP processor 822 and the logic device 816 (e.g., via SPIbuses). Although the UI processor 836 may primarily support UIfunctionality, it may also coordinate with the DSP processor 822 toimplement hazard mitigation in certain forms. For example, the UIprocessor 836 may be programmed to monitor various aspects of user inputand/or other inputs (e.g., touch screen inputs, foot switch inputs,temperature sensor inputs) and may disable the drive output of thegenerator 800 when an erroneous condition is detected.

In certain forms, both the DSP processor 822 and the UI processor 836,for example, may determine and monitor the operating state of thegenerator 800. For the DSP processor 822, the operating state of thegenerator 800 may dictate, for example, which control and/or diagnosticprocesses are implemented by the DSP processor 822. For the UI processor836, the operating state of the generator 800 may dictate, for example,which elements of a UI (e.g., display screens, sounds) are presented toa user. The respective DSP and UI processors 822, 836 may independentlymaintain the current operating state of the generator 800 and recognizeand evaluate possible transitions out of the current operating state.The DSP processor 822 may function as the master in this relationshipand determine when transitions between operating states are to occur.The UI processor 836 maybe aware of valid transitions between operatingstates and may confirm if a particular transition is appropriate. Forexample, when the DSP processor 822 instructs the UI processor 836 totransition to a specific state, the UI processor 836 may verify thatrequested transition is valid. In the event that a requested transitionbetween states is determined to be invalid by the UI processor 836, theUI processor 836 may cause the generator 800 to enter a failure mode.

The non-isolated stage 804 may further comprise a controller 838 formonitoring input devices (e.g., a capacitive touch sensor used forturning the generator 800 on and off, a capacitive touch screen). Incertain forms, the controller 838 may comprise at least one processorand/or other controller device in communication with the UI processor836. In one form, for example, the controller 838 may comprise aprocessor (e.g., a Meg168 8-bit controller available from Atmel)configured to monitor user input provided via one or more capacitivetouch sensors. In one form, the controller 838 may comprise a touchscreen controller (e.g., a QT5480 touch screen controller available fromAtmel) to control and manage the acquisition of touch data from acapacitive touch screen.

In certain forms, when the generator 800 is in a “power off” state, thecontroller 838 may continue to receive operating power (e.g., via a linefrom a power supply of the generator 800, such as the power supply 854discussed below). In this way, the controller 838 may continue tomonitor an input device (e.g., a capacitive touch sensor located on afront panel of the generator 800) for turning the generator 800 on andoff. When the generator 800 is in the power off state, the controller838 may wake the power supply (e.g., enable operation of one or moreDC/DC voltage converters 856 of the power supply 854) if activation ofthe “on/off” input device by a user is detected. The controller 838 maytherefore initiate a sequence for transitioning the generator 800 to a“power on” state. Conversely, the controller 838 may initiate a sequencefor transitioning the generator 800 to the power off state if activationof the “on/off” input device is detected when the generator 800 is inthe power on state. In certain forms, for example, the controller 838may report activation of the “on/off” input device to the UI processor836, which in turn implements the necessary process sequence fortransitioning the generator 800 to the power off state. In such forms,the controller 838 may have no independent ability for causing theremoval of power from the generator 800 after its power on state hasbeen established.

In certain forms, the controller 838 may cause the generator 800 toprovide audible or other sensory feedback for alerting the user that apower on or power off sequence has been initiated. Such an alert may beprovided at the beginning of a power on or power off sequence and priorto the commencement of other processes associated with the sequence.

In certain forms, the isolated stage 802 may comprise an instrumentinterface circuit 840 to, for example, provide a communication interfacebetween a control circuit of a surgical instrument (e.g., a controlcircuit comprising handpiece switches) and components of thenon-isolated stage 804, such as, for example, the logic device 816, theDSP processor 822, and/or the UI processor 836. The instrument interfacecircuit 840 may exchange information with components of the non-isolatedstage 804 via a communication link that maintains a suitable degree ofelectrical isolation between the isolated and non-isolated stages 802,804, such as, for example, an IR-based communication link. Power may besupplied to the instrument interface circuit 840 using, for example, alow-dropout voltage regulator powered by an isolation transformer drivenfrom the non-isolated stage 804.

In one form, the instrument interface circuit 840 may comprise a logiccircuit 842 (e.g., logic circuit, programmable logic circuit, PGA, FPGA,PLD) in communication with a signal conditioning circuit 844. The signalconditioning circuit 844 may be configured to receive a periodic signalfrom the logic circuit 842 (e.g., a 2 kHz square wave) to generate abipolar interrogation signal having an identical frequency. Theinterrogation signal may be generated, for example, using a bipolarcurrent source fed by a differential amplifier. The interrogation signalmay be communicated to a surgical instrument control circuit (e.g., byusing a conductive pair in a cable that connects the generator 800 tothe surgical instrument) and monitored to determine a state orconfiguration of the control circuit. The control circuit may comprise anumber of switches, resistors, and/or diodes to modify one or morecharacteristics (e.g., amplitude, rectification) of the interrogationsignal such that a state or configuration of the control circuit isuniquely discernable based on the one or more characteristics. In oneform, for example, the signal conditioning circuit 844 may comprise anADC circuit for generating samples of a voltage signal appearing acrossinputs of the control circuit resulting from passage of interrogationsignal therethrough. The logic circuit 842 (or a component of thenon-isolated stage 804) may then determine the state or configuration ofthe control circuit based on the ADC circuit samples.

In one form, the instrument interface circuit 840 may comprise a firstdata circuit interface (DCI) 846 to enable information exchange betweenthe logic circuit 842 (or other element of the instrument interfacecircuit 840) and a first data circuit disposed in or otherwiseassociated with a surgical instrument. In certain forms, for example, afirst data circuit may be disposed in a cable integrally attached to asurgical instrument handpiece or in an adaptor for interfacing aspecific surgical instrument type or model with the generator 800. Thefirst data circuit may be implemented in any suitable manner and maycommunicate with the generator according to any suitable protocol,including, for example, as described herein with respect to the firstdata circuit. In certain forms, the first data circuit may comprise anon-volatile storage device, such as an EEPROM device. In certain forms,the first data circuit interface 846 may be implemented separately fromthe logic circuit 842 and comprise suitable circuitry (e.g., discretelogic devices, a processor) to enable communication between the logiccircuit 842 and the first data circuit. In other forms, the first datacircuit interface 846 may be integral with the logic circuit 842.

In certain forms, the first data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information. This informationmay be read by the instrument interface circuit 840 (e.g., by the logiccircuit 842), transferred to a component of the non-isolated stage 804(e.g., to logic device 816, DSP processor 822, and/or UI processor 836)for presentation to a user via an output device and/or for controlling afunction or operation of the generator 800. Additionally, any type ofinformation may be communicated to the first data circuit for storagetherein via the first data circuit interface 846 (e.g., using the logiccircuit 842). Such information may comprise, for example, an updatednumber of operations in which the surgical instrument has been usedand/or dates and/or times of its usage.

As discussed previously, a surgical instrument may be detachable from ahandpiece (e.g., the multifunction surgical instrument may be detachablefrom the handpiece) to promote instrument interchangeability and/ordisposability. In such cases, conventional generators may be limited intheir ability to recognize particular instrument configurations beingused and to optimize control and diagnostic processes accordingly. Theaddition of readable data circuits to surgical instruments to addressthis issue is problematic from a compatibility standpoint, however. Forexample, designing a surgical instrument to remain backwardly compatiblewith generators that lack the requisite data reading functionality maybe impractical due to, for example, differing signal schemes, designcomplexity, and cost. Forms of instruments discussed herein addressthese concerns by using data circuits that may be implemented inexisting surgical instruments economically and with minimal designchanges to preserve compatibility of the surgical instruments withcurrent generator platforms.

Additionally, forms of the generator 800 may enable communication withinstrument-based data circuits. For example, the generator 800 may beconfigured to communicate with a second data circuit contained in aninstrument (e.g., the multifunction surgical instrument). In some forms,the second data circuit may be implemented in a many similar to that ofthe first data circuit described herein. The instrument interfacecircuit 840 may comprise a second data circuit interface 848 to enablethis communication. In one form, the second data circuit interface 848may comprise a tri-state digital interface, although other interfacesmay also be used. In certain forms, the second data circuit maygenerally be any circuit for transmitting and/or receiving data. In oneform, for example, the second data circuit may store informationpertaining to the particular surgical instrument with which it isassociated. Such information may include, for example, a model number, aserial number, a number of operations in which the surgical instrumenthas been used, and/or any other type of information.

In some forms, the second data circuit may store information about theelectrical and/or ultrasonic properties of an associated ultrasonictransducer, end effector, or ultrasonic drive system. For example, thefirst data circuit may indicate a burn-in frequency slope, as describedherein. Additionally or alternatively, any type of information may becommunicated to second data circuit for storage therein via the seconddata circuit interface 848 (e.g., using the logic circuit 842). Suchinformation may comprise, for example, an updated number of operationsin which the instrument has been used and/or dates and/or times of itsusage. In certain forms, the second data circuit may transmit dataacquired by one or more sensors (e.g., an instrument-based temperaturesensor). In certain forms, the second data circuit may receive data fromthe generator 800 and provide an indication to a user (e.g., a lightemitting diode indication or other visible indication) based on thereceived data.

In certain forms, the second data circuit and the second data circuitinterface 848 may be configured such that communication between thelogic circuit 842 and the second data circuit can be effected withoutthe need to provide additional conductors for this purpose (e.g.,dedicated conductors of a cable connecting a handpiece to the generator800). In one form, for example, information may be communicated to andfrom the second data circuit using a one-wire bus communication schemeimplemented on existing cabling, such as one of the conductors usedtransmit interrogation signals from the signal conditioning circuit 844to a control circuit in a handpiece. In this way, design changes ormodifications to the surgical instrument that might otherwise benecessary are minimized or reduced. Moreover, because different types ofcommunications implemented over a common physical channel can befrequency-band separated, the presence of a second data circuit may be“invisible” to generators that do not have the requisite data readingfunctionality, thus enabling backward compatibility of the surgicalinstrument.

In certain forms, the isolated stage 802 may comprise at least oneblocking capacitor 850-1 connected to the drive signal output 810 b toprevent passage of DC current to a patient. A single blocking capacitormay be required to comply with medical regulations or standards, forexample. While failure in single-capacitor designs is relativelyuncommon, such failure may nonetheless have negative consequences. Inone form, a second blocking capacitor 850-2 may be provided in serieswith the blocking capacitor 850-1, with current leakage from a pointbetween the blocking capacitors 850-1, 850-2 being monitored by, forexample, an ADC circuit 852 for sampling a voltage induced by leakagecurrent. The samples may be received by the logic circuit 842, forexample. Based changes in the leakage current (as indicated by thevoltage samples), the generator 800 may determine when at least one ofthe blocking capacitors 850-1, 850-2 has failed, thus providing abenefit over single-capacitor designs having a single point of failure.

In certain forms, the non-isolated stage 804 may comprise a power supply854 for delivering DC power at a suitable voltage and current. The powersupply may comprise, for example, a 400 W power supply for delivering a48 VDC system voltage. The power supply 854 may further comprise one ormore DC/DC voltage converters 856 for receiving the output of the powersupply to generate DC outputs at the voltages and currents required bythe various components of the generator 800. As discussed above inconnection with the controller 838, one or more of the DC/DC voltageconverters 856 may receive an input from the controller 838 whenactivation of the “on/off” input device by a user is detected by thecontroller 838 to enable operation of, or wake, the DC/DC voltageconverters 856.

FIG. 21 illustrates an example of a generator 900, which is one form ofthe generator 800 (FIG. 20 ). The generator 900 is configured to delivermultiple energy modalities to a surgical instrument. The generator 900provides RF and ultrasonic signals for delivering energy to a surgicalinstrument either independently or simultaneously. The RF and ultrasonicsignals may be provided alone or in combination and may be providedsimultaneously. As noted above, at least one generator output candeliver multiple energy modalities (e.g., ultrasonic, bipolar ormonopolar RF, irreversible and/or reversible electroporation, and/ormicrowave energy, among others) through a single port, and these signalscan be delivered separately or simultaneously to the end effector totreat tissue.

The generator 900 comprises a processor 902 coupled to a waveformgenerator 904. The processor 902 and waveform generator 904 areconfigured to generate a variety of signal waveforms based oninformation stored in a memory coupled to the processor 902, not shownfor clarity of disclosure. The digital information associated with awaveform is provided to the waveform generator 904 which includes one ormore DAC circuits to convert the digital input into an analog output.The analog output is fed to an amplifier 1106 for signal conditioningand amplification. The conditioned and amplified output of the amplifier906 is coupled to a power transformer 908. The signals are coupledacross the power transformer 908 to the secondary side, which is in thepatient isolation side. A first signal of a first energy modality isprovided to the surgical instrument between the terminals labeledENERGY₁ and RETURN. A second signal of a second energy modality iscoupled across a capacitor 910 and is provided to the surgicalinstrument between the terminals labeled ENERGY₂ and RETURN. It will beappreciated that more than two energy modalities may be output and thusthe subscript “n” may be used to designate that up to n ENERGYnterminals may be provided, where n is a positive integer greater than 1.It also will be appreciated that up to “n” return paths RETURNn may beprovided without departing from the scope of the present disclosure.

A first voltage sensing circuit 912 is coupled across the terminalslabeled ENERGY₁ and the RETURN path to measure the output voltagetherebetween. A second voltage sensing circuit 924 is coupled across theterminals labeled ENERGY₂ and the RETURN path to measure the outputvoltage therebetween. A current sensing circuit 914 is disposed inseries with the RETURN leg of the secondary side of the powertransformer 908 as shown to measure the output current for either energymodality. If different return paths are provided for each energymodality, then a separate current sensing circuit should be provided ineach return leg. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to respective isolation transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 918. The outputs of the isolationtransformers 916, 928, 922 in the on the primary side of the powertransformer 908 (non-patient isolated side) are provided to a one ormore ADC circuit 926. The digitized output of the ADC circuit 926 isprovided to the processor 902 for further processing and computation.The output voltages and output current feedback information can beemployed to adjust the output voltage and current provided to thesurgical instrument and to compute output impedance, among otherparameters. Input/output communications between the processor 902 andpatient isolated circuits is provided through an interface circuit 920.Sensors also may be in electrical communication with the processor 902by way of the interface circuit 920.

In one aspect, the impedance may be determined by the processor 902 bydividing the output of either the first voltage sensing circuit 912coupled across the terminals labeled ENERGY₁/RETURN or the secondvoltage sensing circuit 924 coupled across the terminals labeledENERGY₂/RETURN by the output of the current sensing circuit 914 disposedin series with the RETURN leg of the secondary side of the powertransformer 908. The outputs of the first and second voltage sensingcircuits 912, 924 are provided to separate isolations transformers 916,922 and the output of the current sensing circuit 914 is provided toanother isolation transformer 916. The digitized voltage and currentsensing measurements from the ADC circuit 926 are provided the processor902 for computing impedance. As an example, the first energy modalityENERGY₁ may be ultrasonic energy and the second energy modality ENERGY₂may be RF energy. Nevertheless, in addition to ultrasonic and bipolar ormonopolar RF energy modalities, other energy modalities includeirreversible and/or reversible electroporation and/or microwave energy,among others. Also, although the example illustrated in FIG. 21 shows asingle return path RETURN may be provided for two or more energymodalities, in other aspects, multiple return paths RETURNn may beprovided for each energy modality ENERGYn. Thus, as described herein,the ultrasonic transducer impedance may be measured by dividing theoutput of the first voltage sensing circuit 912 by the current sensingcircuit 914 and the tissue impedance may be measured by dividing theoutput of the second voltage sensing circuit 924 by the current sensingcircuit 914.

As shown in FIG. 21 , the generator 900 comprising at least one outputport can include a power transformer 908 with a single output and withmultiple taps to provide power in the form of one or more energymodalities, such as ultrasonic, bipolar or monopolar RF, irreversibleand/or reversible electroporation, and/or microwave energy, amongothers, for example, to the end effector depending on the type oftreatment of tissue being performed. For example, the generator 900 candeliver energy with higher voltage and lower current to drive anultrasonic transducer, with lower voltage and higher current to drive RFelectrodes for sealing tissue, or with a coagulation waveform for spotcoagulation using either monopolar or bipolar RF electrosurgicalelectrodes. The output waveform from the generator 900 can be steered,switched, or filtered to provide the frequency to the end effector ofthe surgical instrument. The connection of an ultrasonic transducer tothe generator 900 output would be preferably located between the outputlabeled ENERGY₁ and RETURN as shown in FIG. 21 . In one example, aconnection of RF bipolar electrodes to the generator 900 output would bepreferably located between the output labeled ENERGY₂ and RETURN. In thecase of monopolar output, the preferred connections would be activeelectrode (e.g., pencil or other probe) to the ENERGY₂ output and asuitable return pad connected to the RETURN output.

Additional details are disclosed in U.S. Patent Application PublicationNo. 2017/0086914, titled TECHNIQUES FOR OPERATING GENERATOR FORDIGITALLY GENERATING ELECTRICAL SIGNAL WAVEFORMS AND SURGICALINSTRUMENTS, which published on Mar. 30, 2017, which is hereinincorporated by reference in its entirety.

FIG. 22 illustrates a surgical instrument 29000, in accordance with atleast one aspect of the present disclosure. For the aspects shown inFIG. 22 , the surgical instrument includes a handle 29002, a bendableshaft assembly 29004, an end effector 29006, a motor (not visiblethrough the outer surface of the handle 29002) and a flexible circuit29008. Although the surgical instrument 29000 is shown in FIG. 22 ashaving a bendable shaft assembly 29004, it will be appreciated thataccording to other aspects, the surgical instrument 29000 may include ashaft assembly having an articulation joint in lieu of the bendableportion.

FIG. 23 illustrates a shaft assembly 29005 of the surgical instrument29000, in accordance with at least one other aspect of the presentdisclosure. As shown in FIG. 23 , the shaft assembly 29005 includes anarticulation joint 29010 and is coupled to the end effector 29006 whichincludes a first jaw 29012 and a second jaw 29014, where at least one ofthe first and second jaws 29012, 29014 is configured to pivot between anopen position and a closed position to clamp tissue between the firstand second jaws 29012, 29014. Although the end effector 29006 is shownas including a staple cartridge 29016, it will be appreciated thataccording to other aspects, the end effector 29006 may includeelectrodes in lieu of or in addition to the staple cartridge 29016.

FIG. 24 illustrates the flexible circuit 29008 of the surgicalinstrument 29000 of FIG. 22 . The flexible circuit 2900 is present inthe handle 29002, the shaft assembly 29004/29005 and the end effector29006, and includes processing devices 29018, logic elements 29020,conductive traces 29022 and conductive pads 29024. Although only oneprocessing device 29018 and one logic element 29020 are shown in FIG. 23, it will be appreciated that the flexible circuit 29008 may include anynumber of processing devices 29018 and/or logic elements 29020. Theconductive pads 29024 are configured for connection to other componentsof the surgical instrument 29000 such as sensing devices as describedabove, a motor (See conductive pads A and B in FIG. 24 ) and slip rings(See conductive pads C and D in FIG. 24 ). The conductive traces 29022carry signals from sensors, to and from processing devices 29018, to andfrom logic elements 29020, to and from control circuits, to motors, etc.Although not shown for purposes of simplicity, the flexible circuit29008 can also include a substrate, one or more insulation layers and anoverlay. The processing devices 29018, logic elements 29020, etc. can bemounted on the substrate and the conductive traces 29022 and conductivepads 29024 can be patterned onto/over the substrate. The one or moreinsulation layers electrically insulate the conductive traces from oneanother. The overlay covers the insulation layer and/or the processingdevices 29018, logic elements 29020, conductive traces 29022 andconductive pads 29024. The flexible circuit 29008 can be one-sided asshown in FIG. 24 , or double-sided or multilayer. The conductive traces29022 and conductive pads 29024 can include copper, gold, tin and/orother suitable conductive materials.

According to various aspects, in order to isolate the conductive traces29022 from radiofrequency energy delivered by the surgical instrument29000, the flexible circuit 29008 includes electromagnetic shielding(e.g., guard traces or guard rings) that blocks radiofrequencyelectromagnetic radiation and/or minimizes signal cross-talk between thevarious conductive traces 29022. The electromagnetic shielding does nothave to be included throughout the flexible circuit 29008. For example,according to various aspects, the electromagnetic shielding may only bepositioned in select locations of the flexible circuit 29008 to protectthe conductive traces 29022 from being subjected to unwanted effects orsignals caused by external radiofrequency generators or magnets. Forpurposes of simplicity, the electromagnetic shielding is not shown inFIG. 24 .

The flexible circuit 29008 includes both rigid sections 29026 andflexible sections 29028. Thus, the flexible circuit 29008 may also bereferred to as a rigid-flex circuit. The rigid sections 29026 may bereinforced and are configured not to bend or flex to any significantdegree. The rigid sections 29026 include portions of the conductivetraces 29022, and can also include, for example, one or more processingdevices 29018, one or more integrated circuits, one or more logicelements 29020 and/or conductive pads 29024 as shown in FIG. 24 . Theactual positioning of devices such as non-chip gates and other logicelements 29020 allow for low level decision making local to theactuators of the surgical instrument 29000 (e.g., distributedprocessing).

According to various aspects, a first rigid section 29026 of theflexible circuit 29008 proximal to the articulation joint 29010 of theshaft assembly 29005 includes an interlock feature 29030 which isconfigured to snap into a recess 29032 defined by a first channelretainer 29034 (See FIG. 25 ), and a second rigid section 29026 of theflexible circuit 29008 distal to the articulation joint 29010 of theshaft assembly 29005 includes an interlock feature which is configuredto snap into a recess defined by a second channel retainer. Although theinterlock feature of the second rigid section, the second channelretainer and its recess are not shown in FIG. 24 for purposes ofsimplicity, it will be appreciated that other than the positioning(proximal versus distal relative to the articulation joint), theinterlock feature of the second rigid section may be similar oridentical to the interlock feature 29030 of the first rigid section29026, the second channel retainer may be similar or identical to thefirst channel retainer 29034, and the recess of the second channelretainer may be similar or identical to the recess 29032 of the firstchannel retainer 29034. The first and second channel retainers 29034 arefixed within the surgical instrument 29000 and do not move relative tothe surgical instrument 29000. The snap-fit connection of the rigidsections 29026 to the channel retainers 29034 allows for the flexiblecircuit 29008 to be attached to the surgical instrument 29000 andprevents the flexible circuit 29008 from being “pulled-out” of positionwhen the surgical instrument 29000 is required to be moved in variousdirections and/or the flexible circuit 29008 is subjected to variousforces.

The flexible sections 29028 are configured to flex and bend as needed.For example, for a flexible section 29028 that is aligned with an activebending portion of the shaft assembly 20004 or with an articulatingportion of the shaft assembly 29005 of the surgical instrument 29000,the flexible section 29028 also needs to bendable in a similar manner toprevent unwanted stresses being applied to the flexible section 29028and/or failure of the flexible section 29028. Similarly, for instanceswhere the flexible section 29028 needs to be stepped to cross over amechanical component of the surgical instrument 29000 (e.g., anarticulation rod of the surgical instrument), a flexible section 29028of the flexible circuit 29008 allows for this to be realized (see, e.g.,FIG. 23 ). When the flexible circuit 29008 has forces, torsion ordeformations applied to it, the flexible portions 29028 allow for theflexible circuit 29008 to flex more in one direction than in otherdirections, thereby preventing damage to the flexible circuit 29008 dueto loading.

The flexible sections 29028 include portions of the conductive traces29022, can be stepped to cross over one or more mechanical components asdescribed above, and/or can be folded in certain potentially high-stressareas (e.g., within an active bending portion of the shaft assembly29004 as shown in FIG. 22 or within an articulation joint 29010 of theshaft assembly 29005) in order to provide increased maneuverability,strength and/or resistance to failure.

According to various aspects, the respective cross-sections of theconductive traces 29022 can vary throughout the flexible circuit 29008,even though the conductive traces 29022 still have the same orsubstantially similar current carrying capacity. The respective heights(h) or thicknesses of the conductive traces 29022 can be varied and/orthe respective widths (w) of the conductive traces 29022 can be varied.For example, for a given conductive trace 29022 that is present in botha rigid section 29026 and a flexible section 29028, the height (h) ofthe conductive trace 29022 may be greater in the rigid section 29026than in the flexible section 29028, and the width (W) of conductivetrace 29022 may be greater in the flexible section 29028 than in therigid section 29026. The combination of a lower height and a greaterwidth in the flexible section 29028 allows the conductive trace 29022 tobe more tolerable of the high stresses introduced by motions such asarticulation motions and/or jaw closure motions. The length L shown inFIG. 24 is representative of the length of the articulating portion ofthe shaft assembly 29005 relative to the conductive traces 29022 alignedwith the articulation joint 29010.

FIG. 26 illustrates a cross-section of the flexible circuit 29008 alongthe line A-A of FIG. 24 , in accordance with at least one aspect of thepresent disclosure. The portion of the flexible circuit 29008 along theline A-A is distal to the bending portion of the shaft assembly29004/the articulation joint 29010 of the shaft assembly 29005 and maybe considered a rigid portion 29026. As shown in FIGS. 24 and 26 , theflexible circuit 29008 is not separated along the line A-A and therespective conductive traces 29022 in this portion of the flexiblecircuit 29008 have a height h_(a) and a width W_(a).

FIG. 27 illustrates a cross-section of the flexible circuit 29008 alongthe line B-B of FIG. 24 , in accordance with at least one aspect of thepresent disclosure. The portion of the flexible circuit 29008 along theline B-B is proximal to the bending portion of the shaft assembly29004/the articulation joint 29010 of the shaft assembly 29005 and maybe considered a flexible portion 29028. As shown in FIGS. 24 and 27 ,the flexible circuit 29008 defines a separation or opening 29036 alongthe line B-B and the respective conductive traces 29022 in this portionof the flexible circuit 29008 have a height h_(b) and a width W_(b).

By comparing FIGS. 26 and 27 , it is apparent that the height (h_(a)) ofthe portions of the respective conductive traces 29022 along the lineA-A (the portions of the conductive traces 29022 in the rigid section29026) is greater than the height (h_(b)) of the portions of therespective conductive traces 29022 along the line B-B (the portions ofthe conductive traces 29022 in the flexible section 29028). Similarly,it is also apparent that the width (W_(a)) of the portions of therespective conductive traces 29022 along the line A-A (the portions ofthe conductive traces 29022 in the rigid section 29026) is less than thewidth (W_(b)) of the portions of the respective conductive traces 29022along the line B-B (the portions of the conductive traces 29022 in theflexible section 29028). Stated differently, as depicted in FIG. 26 ,h_(a)>h_(b) and W_(a)<W_(b).

For aspects of the surgical instrument 29000, which include thearticulation joint 29010 in the shaft assembly 29005, for the portion ofthe flexible circuit 29008, which passes through the articulation joint29010 (a flexible section 29028 of the flexible circuit 29008), theportions of the respective conductive traces 29022 are shorter/thinnerand wider than the portions of the corresponding conductive traces 29022are in the rigid section 29026, which is distal and adjacent to theflexible section 29028. Whereas traditional wires in this regiontypically have to be augmented with strain relief, the conductive traces29022 of the flexible circuit 29008 in this region are madeshorter/thinner and wider to allow the conductive traces 29022 of thisflexible section 29028 to have the same current carrying capacity ofthose in the rigid sections 29026 while improving their flexibility. Inview of the above, it will be appreciated that, a flexible section 29028of the flexible circuit 29008 may be aligned to a pivot axis of thearticulation joint 29010 of the shaft assembly 29005, thereby allowingthe flexible circuit 29008 to be bent up to 90° (or more) relative to alongitudinal axis 29038 of the shaft assembly 29005 and/or of thesurgical instrument 29000. Similar functionality can be realized for aportion of the flexible circuit 29008, which passes through a pivotjoint of the end effector 29006 and/or through the first and/or secondjaws 29012, 29014 of the surgical instrument 29000. Thus, it can beappreciated that the flexible circuit 29008 includes elements (e.g.,conductive traces 29022) that have variable cross-sections where theyare aligned with joints (e.g., the articulation joint 29010 of the shaftassembly 29005 and/or the pivot joint of the end effector 29006) of thesurgical instrument 29000.

As shown in FIG. 22 , for the portion of the flexible circuit 29008,which passes through the bendable portion of the shaft assembly 29004(or through the articulation joint 29010 of the shaft assembly 29005),the flexible circuit 29008 may be folded on each side of the separationor opening 29040 similar to a manner of that shown in FIG. 22 . Thefolding on each side of the separation or opening 29040 and theflexibility of the conductive traces 29022 allows for the wider portionsof the conductive traces 29022 of the flexible section 29028 to fitwithin the limited area available within the articulation joint 29010 ofthe shaft assembly 29005.

According to various aspects, the flexible circuit 29008 can include atwist or strain relief section 29042 incorporated into the flexiblecircuit 29008. As shown in FIG. 22 , according to various aspects, thetwist or strain relief section 29042 can be positioned between a rigidsection 29026, which includes the interlock feature 29030 and a flexiblesection 29028 which passes through the articulation joint 29010 of theshaft assembly 29005. The twist or strain relief section 29042 allowsthe flexible circuit 29008 to first be attached to the first channelretainer 29034 (along a first plane along a length of the shaft assembly29005 proximal to the articulation joint 29010), then twistapproximately 90° relative to the first plane to allow articulationabout an axis perpendicular to the first plane). The twist or strainrelief section 29042 is configured to safely relieve strains imposed onthe flexible circuit 29008.

By incorporating both rigid sections 29026 and flexible sections 29028into the flexible circuit 29008 of the surgical instrument 29000, theflexible circuit 29008 can mirror movements of the active bendingsections of the shaft assembly 29004 or the articulation joint 29010 ofthe shaft assembly 29005 of the surgical instrument 29000 whileremaining properly positioned within the surgical instrument 29000. Sucha combination provides a flexible circuit 29008, which is more resistantto failure than those typically associated with surgical instruments29000.

FIG. 28 illustrates an exploded view of a flexible electrode 29100 ofthe surgical instrument 29000 of FIG. 22 , in accordance with at leastone aspect of the present disclosure. According to various aspects, theflexible electrode 29100 can be integrated into the flexible circuit29008 of FIG. 22 or at least be electrically coupled to the flexiblecircuit 29008. Although not shown for purposes of clarity, it will beappreciated that the flexible electrode 29100 can be coupled to anelectrosurgical generator and can receive electrosurgical energy(alternating current at RF levels) supplied by the electrosurgicalgenerator.

The flexible electrode 29100 can be positioned on the first or secondjaw 29012, 29014 of the end effector 29006 of the surgical instrument29000 and includes a therapeutic electrode 29102 and a sensing electrode29104. The therapeutic electrode 29102 and the sensing electrode 29104can include copper, gold, tin, or any other suitable material forconducting electricity.

The therapeutic electrode 29102 can have a rectangular shape and isconfigured to deliver RF energy to tissue positioned between the firstand second jaws 29012, 29014 of the surgical instrument 29000. Accordingto various aspects, the therapeutic electrode 29102 can have a thicknessin the range of about 0.003 inches.

The sensing electrode 29104 is configured to help determine one or moreparameters associated with tissue positioned between the first andsecond jaws 29012, 29014 of the surgical instrument 29000. For example,the sensing electrode 29104 may be configured to help determine theimpedance of the tissue positioned between the first and second jaws29012, 29014 of the surgical instrument 29000. By sensing an amplitude,a frequency, a phase shift, etc., of a current passing through thetissue, the sensing electrode 29104 can pass the sensed “value” along toa processing circuit of the surgical instrument 29000, which can thendetermine the impedance of the tissue positioned between the first andsecond jaws 29012, 29014 of the surgical instrument 29000. An example ofsuch a sensing electrode is described in commonly owned U.S. Pat. No.5,817,093, titled IMPEDANCE FEEDBACK MONITOR WITH QUERY ELECTRODE FORELECTROSURGICAL INSTRUMENT, issued Oct. 6, 1998, the entire contents ofwhich are hereby incorporated by reference. The sensing electrode 29104can be continually sensing, even when RF energy is being delivered tothe tissue by the therapeutic electrode 29102 for welding the tissue.According to various aspects, the sensing electrode 29104 can have athickness similar or identical to the thickness of the therapeuticelectrode 29102 (e.g., in the range of about 0.003 inches).

According to various aspects, the sensing electrode 29104 may also beconfigured to help determine tissue shrinkage and/or temperaturetransition points in the tissue. For example, by sensing an amplitude, afrequency, a phase shift, etc., of a current passing through the tissue,the sensing electrode 29104 can pass the sensed “value” along to aprocessing circuit of the surgical instrument 29000, which can thenutilize the sensed “values” to determine the electrical continuity ofthe tissue positioned between the first and second jaws 29012, 29014 ofthe surgical instrument 29000. The processing circuit can then utilizethe determined electrical continuity of the tissue to help determine thetissue shrinkage. When utilized in connection with the therapeuticelectrodes 29102, the sensing electrodes 29104 can allow for thedetection of approaching transition temperature points associated withthe tissue welding as the sensing electrodes 29104 are at a higherpressure than the therapeutic electrodes 29102 are. By utilizing thesensing capability of the sensing electrodes 29104, the sensed “values”can be passed along to the processing circuit of the surgical instrument29000, which can then utilize the sensed “values” to identify impedanceevents before temperature transition points/inflection points occur inthe less compressed zones of the tissue.

The sensing electrode 29104 has a patterned shape, overlays thetherapeutic electrode 29102 and can have the same overall length andwidth of the therapeutic electrode 29102, but due to the patterned shapedoesn't completely cover the therapeutic electrode 29102. As shown inFIG. 28 , according to various aspects the sensing electrode 29104 canbe patterned as a modified “E-shape” with multiple rectangular fingers29106. When the sensing electrode 29104 overlays the therapeuticelectrode 29102, the spaces 29108 between the multiple rectangularfingers 29106 of the modified E-shape of the sensing electrode 29104 arealigned with portions of the therapeutic electrode 29102 which remainuncovered. According to other aspects, the patterned shape of thesensing electrode 29104 can be a modified E-shape with multipletriangular fingers or other shaped fingers.

The flexible electrode 29100 also includes a first insulative layer29110 positioned between the therapeutic electrode 29102 and the sensingelectrode 29104. The first insulative layer 29110 can be patterned inthe same manner as the sensing electrode 29104 (e.g., a modified E-shapewith multiple rectangular fingers 29112), is aligned with the sensingelectrode 29104, and electrically isolates the sensing electrode 29104from the therapeutic electrode 29102. According to various aspects, thefirst insulative layer 29110 is congruent with the sensing electrode29104. According to various aspects, when the first insulative layer29110 overlays the therapeutic electrode 29102, the spaces 29114 betweenthe multiple rectangular fingers 29112 of the modified E-shape of thefirst insulative layer 29110 are aligned with the spaces 29108 betweenthe multiple rectangular fingers 29106 of the modified E-shape of thesensing electrode 29104, which are aligned with portions of thetherapeutic electrode 29102, which remain uncovered. According to otheraspects, the multiple rectangular fingers 29112 of the modified E-shapeof the first insulative layer 29110 can be slightly wider than themultiple rectangular fingers 29106 of the modified E-shape of thesensing electrode 29104 (see FIGS. 29 and 30 ) such that the spaces29114 can be slightly narrower than the spaces 29108. According tovarious aspects, the first insulative layer 29110 has a thickness in therange of about 0.001 inches to 0.0003 inches. The first insulative layer29110 may include any suitable electrically non-conductive material andcan be more flexible than either the therapeutic electric 29102 or thesensing electrode 29104.

The flexible electrode 29100 also includes a second insulative layer29116 positioned to cover the surface of the therapeutic electrode 29102opposite the surface of the therapeutic electrode 29102, which ispartially covered by the first insulative layer 29110 and the sensingelectrode 29104. The second insulative layer 29116 can have arectangular shape which has the same overall length and width as thetherapeutic electrode 29102. According to various aspects, the secondinsulative layer 29116 can have a thickness in the range of about 0.0001inches to 0.003 inches. The second insulative layer 29116 may includeany suitable electrically non-conductive material and can be moreflexible than either the therapeutic electric 29102 or the sensingelectrode 29104.

Although only one flexible electrode 29100 is shown in FIG. 28 forpurposes of clarity, it is understood that the surgical instrument 29000can include at least two of the flexible electrodes 29100 (e.g., one onthe left hand side of a knife slot of the end effector 29006 of thesurgical instrument 29000 and one on the right hand side of the knifeslot). Additionally, as the flexible electrode 29100 includes multiplecomponents and multiple layers, it will be appreciated that the flexibleelectrode 29100 can be considered a flexible electrode assembly and/or amulti-layered flexible electrode.

FIGS. 29 and 30 illustrate top views of a flexible electrode assembly29200, in accordance with at least one aspect of the present disclosure.The flexible electrode assembly 29200 includes two of the flexibleelectrodes 29100 of FIG. 28 , with a first one of the flexibleelectrodes 29100 a positioned on the left hand side of a knife slot29202 of the end effector 29006 of the surgical instrument 29000 and asecond one of the flexible electrodes 29100 b positioned on the righthand side of the knife slot 29202. With respect to the top views shownin FIGS. 29 and 30 , the sensing electrodes 29104 a and 29104 b arepositioned above and partially cover the therapeutic electrodes 29102 aand 29102 b.

The surfaces of the respective sensing electrodes 29104 a, 29104 b,which can be in direct contact with tissue positioned between the firstand second jaws 29012, 29014 of the surgical instrument 29000, are shownas being darkened in FIG. 29 . The darkened surfaces in FIG. 29 can beconsidered sensing electrode patterns. As set forth above, the sensingelectrodes 29104 can help to determine the impedance of tissuepositioned between the first and second jaws 29012, 29014 of thesurgical instrument 29000. When utilized in connection with thetherapeutic electrodes 29102, the sensing electrodes 29104 can allow forthe detection of approaching transition temperature points associatedwith the tissue welding as the sensing electrodes 29104 are at a higherpressure than the therapeutic electrodes 29102 are. By utilizing themeasurement capability of the sensing electrodes 29104, impedance eventscan be identified before the inflection points occur in the lesscompressed zones of the tissue. Additionally, the sensing electrodes29014 can also allow for measurement of tissue shrinkage if electricalcontinuity is measured by them. By using the sensing electrodes 29104 tomeasure continuity rather than impedance, the measured parameter can beindicative of tissue shrinkage rather than water driven out of thetissue. Furthermore, the sensing electrodes 29104 can be utilized tomeasure both impedance and continuity of the tissue. According tovarious aspects, the sensing electrodes 29104 can be also used as aconductive gap spacer to control a minimum gap between the first andsecond jaws 29012, 29014 of the surgical instrument 29000.

The recessed, non-continuous portions of the surfaces of the respectivetherapeutic electrodes 29102 a, 29102 b, which can be in direct contactwith tissue positioned between the jaws of the surgical instrument29000, are shown as being darkened in FIG. 30 . The darkened surfaces inFIG. 30 can be considered therapeutic electrode patterns. Due to therecessed, segmented, non-continuous nature of the surfaces of thetherapeutic electrodes 29102 a, 29102 b which can be in direct contactwith tissue positioned between the first and second jaws 29012, 29014 ofthe surgical instrument 29000, the therapeutic electrodes 29102 canmitigate any unwanted tissue sticking when the therapeutic electrodes29102 are energized. According to various aspects, a given recessed,non-continuous portion of a therapeutic electrode 29102 between twoadjacent rectangular shaped fingers 29106 of a sensing electrode 29104can be in the range of about 0.005″ to 0.0008″ greater in thelongitudinal direction than the “length” of one of the rectangularshaped fingers 29106. Stated differently, the surface area of a givenrecessed, non-continuous portion of a therapeutic electrode 29102between two adjacent rectangular shaped fingers 29106 of a sensingelectrode 29104 can be greater than the surface area of one of therectangular shaped fingers 29106 of the sensing electrode 29104.According to various aspects, at least one of the recessed, segmented,non-continuous portions of the surfaces of the therapeutic electrodes29102 can be positioned in an offset or opposed electrode arrangementand can be coupled to a current return path which in turn can be coupledto an electrosurgical generator.

In view of the above, it will be appreciated that the flexible electrodeassembly 29200 is a multi-level flexible electrode, which can measureone or more parameters associated with the surgical instrument 29000and/or tissue positioned between the first and second jaws 29012, 29014of the surgical instrument 29000 and can also cauterize the tissue.

FIG. 31 illustrates an exploded view of a flexible electrode 29300 ofthe surgical instrument 29000 of FIG. 22 , in accordance with at leastone other aspect of the present disclosure. The flexible electrode 29300of FIG. 31 is similar to the flexible electrode 29100 of FIG. 28 , butis different in that the flexible electrode 29300 of FIG. 31 furtherincludes a third insulative layer 29302 positioned to partially coverthe surface of the sensing electrode 29104 opposite the surface of thesensing electrode 29104, which is covered by the first insulative layer29110. The third insulative layer 29302 can have a rectangular shapethat has the same overall length as the sensing electrode 29104, thefirst insulative layer 29110, and/or the therapeutic electrode 29102 buthas a width which is less than the width of the sensing electrode 29104,the first insulative layer 29110, the therapeutic electrode 29102,and/or the second insulative layer 29116. For example, according tovarious aspects, the third insulative layer 29302 can have a width whichcovers all of the sensing electrode 29104 except for the rectangularshaped fingers 29106. According to other aspects, the third insulativelayer 29302 can have a width that does not cover the rectangular shapedfingers 29106 and only partially covers the remaining portion of thesensing electrode 29104. According to various aspects, the thirdinsulative layer 29302 can have a thickness in the range of about 0.0001inches to 0.003 inches. The third insulative layer 29302 may include anysuitable electrically non-conductive material and can be more flexiblethan either the therapeutic electric 29102 or the sensing electrode29104.

FIG. 32 illustrates an end view of a flexible electrode 29400 of thesurgical instrument 29000 of FIG. 22 , in accordance with at least oneother aspect of the present disclosure. The flexible electrode 29400 ofFIG. 32 is similar to the flexible electrode of FIG. 31 but isdifferent. For the flexible electrode 29400 of FIG. 32 , the firstinsulative layer 29110 extends past the left hand side and the righthand side of the sensing electrode 29104 (relative to FIG. 32 ), thesecond insulative layer 29116 extends past the left hand side and theright hand side of the therapeutic electrode 29102, and the thirdinsulative layer 29302 extends past one of the sides of the sensingelectrode 29104. In addition, the flexible electrode 29400 of FIG. 32also includes insulative material 29402, which covers one of the sidesof the therapeutic electrode 29102 and one of the sides of the sensingelectrode 29102 and connects the first, second, and third insulativelayers 29110, 29116, 29302 together. The insulative material 29402 maybe similar or identical to the material of the first, second, and/orthird insulative layers 29110, 29116, 29302 and can be more flexiblethan either the therapeutic electrode 29102 or the sensing electrode29104. Furthermore, the flexible electrode 29400 of FIG. 32 can be alaminar composite construction that allows for multiple portions of thesensing electrode 29104 and/or the therapeutic electrode 29102 to be incontact with tissue positioned between the jaws of the surgicalinstrument 29000, including portions of the sensing electrode 29104and/or therapeutic electrode 29102, which are buried within the laminatestructure.

FIG. 33 illustrates a top perspective view of a flexible electrode 29500of the surgical instrument 29000 of FIG. 22 , in accordance with atleast one other aspect of the present disclosure. As shown in FIG. 33 ,the flexible electrode 29500 further includes additional insulativematerial 29504, which covers the side of the sensing electrode 29104opposite the side that is covered by the insulative material 29402. Theadditional insulative material 29504 may be similar or identical to thematerial of the insulative material 29402 as well as the material of thefirst, second, and/or third insulative layers 29110, 29116, 29302. Theadditional insulative material 29504 can be more flexible than eitherthe therapeutic electrode 29102 or the sensing electrode 29104. As shownin FIG. 33 , a long thin portion 29506 of the therapeutic electrode29104 is uncovered and can be in direct contact with tissue positionedbetween the first and second jaws 29012, 29014 of the surgicalinstrument 29000. The limited surface area of the long thin uncoveredportion 29506 of the therapeutic electrode 29104 can mitigate anyunwanted tissue sticking. Similarly, the non-continuous portions of thetherapeutic electrode 29102 that are not covered by the first insulativemember 29110 and/or the sensing electrode 29104 can also be in directcontact with tissue positioned between the first and second jaws 29012,29014 of the surgical instrument 29000 and can also mitigate anyunwanted tissue sticking.

As set forth above, one or more of the flexible electrodes 29100, 29200,29300, 29400, 29500 can form part of a flexible circuit 29008 of thesurgical instrument 29000. According to various aspects, a terminationcontact arrangement can enable the flexible circuit 29008 to be easilyattached to or connected with other connections and/or circuits withinthe surgical instrument 29000. The termination contact arrangement canprovide strain relief to the flexible circuit 29008 and the strainrelief can mitigate damage to the portion of the flexible circuit 29008adjacent the connection. The termination contact arrangement can alsomaintain the connection in a water-tight manner. According to variousaspects, the termination contact arrangement can be a zero insertionforce (ZIF) connector that electrically connects the flexible circuit29008 with other connections and/or circuits within the surgicalinstrument 29000. Such a ZIF connector can include both a self-sealingconnection against fluids and provide strain relief to the portion ofthe flexible circuit 29008 adjacent the ZIF connector.

By incorporating therapeutic electrodes 29102 and sensing electrodes29104 into flexible electrodes, the flexible electrodes can apply RFenergy to tissue positioned between the first and second jaws 29012,29014 of the surgical instrument 29000 while also measuring parametersassociated with the tissue and/or the surgical instrument 29000. Withthe above-described configuration, the sensing electrodes 29104 cancontinually sense the parameters, even when the therapeutic electrodes29102 are applying RF energy to the tissue for welding. Additionally,due to the partial overlapping of the “contact surface” of thetherapeutic electrodes 29102 by the sensing electrodes 29104 and/or thefirst insulative layer 29110, the therapeutic electrodes 29102 have lesssurface area in contact with the tissue and thus are less likely tocontribute to unwanted tissue sticking. Furthermore, due to the inherentflexibility of the flexible electrodes, the therapeutic electrodes 29102are less likely to experience premature failure due to unwanted flexingor deformation than electrodes typically associated with surgicalinstruments.

FIGS. 21-24 depict a motor-driven surgical instrument 150010 for cuttingand fastening that may or may not be reused. In the illustratedexamples, the surgical instrument 150010 includes a housing 150012 thatcomprises a handle assembly 150014 that is configured to be grasped,manipulated, and actuated by the clinician. The housing 150012 isconfigured for operable attachment to an interchangeable shaft assembly150200 that has an end effector 150300 operably coupled thereto that isconfigured to perform one or more surgical tasks or procedures. Inaccordance with the present disclosure, various forms of interchangeableshaft assemblies may be effectively employed in connection withrobotically controlled surgical systems. The term “housing” mayencompass a housing or similar portion of a robotic system that housesor otherwise operably supports at least one drive system configured togenerate and apply at least one control motion that could be used toactuate interchangeable shaft assemblies. The term “frame” may refer toa portion of a handheld surgical instrument. The term “frame” also mayrepresent a portion of a robotically controlled surgical instrumentand/or a portion of the robotic system that may be used to operablycontrol a surgical instrument. Interchangeable shaft assemblies may beemployed with various robotic systems, instruments, components, andmethods disclosed in U.S. Pat. No. 9,072,535, titled SURGICAL STAPLINGINSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, which isherein incorporated by reference in its entirety.

FIG. 34 is a perspective view of a surgical instrument 150010 that hasan interchangeable shaft assembly 150200 operably coupled thereto, inaccordance with at least one aspect of the present disclosure. Thehousing 150012 includes an end effector 150300 that comprises a surgicalcutting and fastening device configured to operably support a surgicalstaple cartridge 150304 therein. The housing 150012 may be configuredfor use in connection with interchangeable shaft assemblies that includeend effectors that are adapted to support different sizes and types ofstaple cartridges, have different shaft lengths, sizes, and types. Thehousing 150012 may be employed with a variety of interchangeable shaftassemblies, including assemblies configured to apply other motions andforms of energy, such as RF energy, ultrasonic energy, and/or motion toend effector arrangements adapted for use in connection with varioussurgical applications and procedures. The end effectors, shaftassemblies, handles, surgical instruments, and/or surgical instrumentsystems can utilize any suitable fastener, or fasteners, to fastentissue. For instance, a fastener cartridge comprising a plurality offasteners removably stored therein can be removably inserted into and/orattached to the end effector of a shaft assembly.

The handle assembly 150014 may comprise a pair of interconnectablehandle housing segments 150016, 150018 interconnected by screws, snapfeatures, adhesive, etc. The handle housing segments 150016, 150018cooperate to form a pistol grip portion 150019 that can be gripped andmanipulated by the clinician. The handle assembly 150014 operablysupports a plurality of drive systems configured to generate and applycontrol motions to corresponding portions of the interchangeable shaftassembly that is operably attached thereto. A display may be providedbelow a cover 150045.

FIG. 35 is an exploded assembly view of a portion of the surgicalinstrument 150010 of FIG. 34 , in accordance with at least one aspect ofthe present disclosure. The handle assembly 150014 may include a frame150020 that operably supports a plurality of drive systems. The frame150020 can operably support a “first” or closure drive system 150030,which can apply closing and opening motions to the interchangeable shaftassembly 150200. The closure drive system 150030 may include anactuator, such as a closure trigger 150032 pivotally supported by theframe 150020. The closure trigger 150032 is pivotally coupled to thehandle assembly 150014 by a pivot pin 150033 to enable the closuretrigger 150032 to be manipulated by a clinician. When the cliniciangrips the pistol grip portion 150019 of the handle assembly 150014, theclosure trigger 150032 can pivot from a starting or “unactuated”position to an “actuated” position and more particularly to a fullycompressed or fully actuated position.

The handle assembly 150014 and the frame 150020 may operably support afiring drive system 150080 configured to apply firing motions tocorresponding portions of the interchangeable shaft assembly attachedthereto. The firing drive system 150080 may employ an electric motor150082 located in the pistol grip portion 150019 of the handle assembly150014. The electric motor 150082 may be a DC brushed motor having amaximum rotational speed of approximately 25,000 RPM, for example. Inother arrangements, the motor may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The electric motor 150082 may be powered by a powersource 150090 that may comprise a removable power pack 150092. Theremovable power pack 150092 may comprise a proximal housing portion150094 configured to attach to a distal housing portion 150096. Theproximal housing portion 150094 and the distal housing portion 150096are configured to operably support a plurality of batteries 150098therein. Batteries 150098 may each comprise, for example, an LI or othersuitable battery. The distal housing portion 150096 is configured forremovable operable attachment to a control circuit board 150100, whichis operably coupled to the electric motor 150082. Several batteries150098 connected in series may power the surgical instrument 150010. Thepower source 150090 may be replaceable and/or rechargeable. A display150043, which is located below the cover 150045, is electrically coupledto the control circuit board 150100. The cover 150045 may be removed toexpose the display 150043.

The electric motor 150082 can include a rotatable shaft (not shown) thatoperably interfaces with a gear reducer assembly 150084 mounted inmeshing engagement with a set, or rack, of drive teeth 150122 on alongitudinally movable drive member 150120. The longitudinally movabledrive member 150120 has a rack of drive teeth 150122 formed thereon formeshing engagement with a corresponding drive gear 150086 of the gearreducer assembly 150084.

In use, a voltage polarity provided by the power source 150090 canoperate the electric motor 150082 in a clockwise direction wherein thevoltage polarity applied to the electric motor by the battery can bereversed in order to operate the electric motor 150082 in acounter-clockwise direction. When the electric motor 150082 is rotatedin one direction, the longitudinally movable drive member 150120 will beaxially driven in the distal direction “DD.” When the electric motor150082 is driven in the opposite rotary direction, the longitudinallymovable drive member 150120 will be axially driven in a proximaldirection “PD.” The handle assembly 150014 can include a switch that canbe configured to reverse the polarity applied to the electric motor150082 by the power source 150090. The handle assembly 150014 mayinclude a sensor configured to detect the position of the longitudinallymovable drive member 150120 and/or the direction in which thelongitudinally movable drive member 150120 is being moved.

Actuation of the electric motor 150082 can be controlled by a firingtrigger 150130 that is pivotally supported on the handle assembly150014. The firing trigger 150130 may be pivoted between an unactuatedposition and an actuated position.

Turning back to FIG. 34 , the interchangeable shaft assembly 150200includes an end effector 150300 comprising an elongated channel 150302configured to operably support a surgical staple cartridge 150304therein. The end effector 150300 may include an anvil 150306 that ispivotally supported relative to the elongated channel 150302. Theinterchangeable shaft assembly 150200 may include an articulation joint150270. Construction and operation of the end effector 150300 and thearticulation joint 150270 are set forth in U.S. Patent ApplicationPublication No. 2014/0263541, titled ARTICULATABLE SURGICAL INSTRUMENTCOMPRISING AN ARTICULATION LOCK, which is herein incorporated byreference in its entirety. The interchangeable shaft assembly 150200 mayinclude a proximal housing or nozzle 150201 comprised of nozzle portions150202, 150203. The interchangeable shaft assembly 150200 may include aclosure tube 150260 extending along a shaft axis SA that can be utilizedto close and/or open the anvil 150306 of the end effector 150300.

Also on FIG. 34 , the closure tube 150260 is translated distally(direction “DD”) to close the anvil 150306, for example, in response tothe actuation of the closure trigger 150032 in the manner described inthe aforementioned reference U.S. Patent Application Publication No.2014/0263541. The anvil 150306 is opened by proximally translating theclosure tube 150260. In the anvil-open position, the closure tube 150260is moved to its proximal position.

FIG. 36 is another exploded assembly view of portions of theinterchangeable shaft assembly 150200, in accordance with at least oneaspect of the present disclosure. The interchangeable shaft assembly150200 may include a firing member 150220 supported for axial travelwithin the spine 150210. The firing member 150220 includes anintermediate firing shaft 150222 configured to attach to a distalcutting portion or knife bar 150280. The firing member 150220 may bereferred to as a “second shaft” or a “second shaft assembly.” Theintermediate firing shaft 150222 may include a longitudinal slot 150223in a distal end configured to receive a tab 150284 on the proximal end150282 of the knife bar 150280. The longitudinal slot 150223 and theproximal end 150282 may be configured to permit relative movementtherebetween and can comprise a slip joint 150286. The slip joint 150286can permit the intermediate firing shaft 150222 of the firing member150220 to articulate the end effector 150300 about the articulationjoint 150270 without moving, or at least substantially moving, the knifebar 150280. Once the end effector 150300 has been suitably oriented, theintermediate firing shaft 150222 can be advanced distally until aproximal sidewall of the longitudinal slot 150223 contacts the tab150284 to advance the knife bar 150280 and fire the staple cartridgepositioned within the channel 150302. The spine 150210 has an elongatedopening or window 150213 therein to facilitate assembly and insertion ofthe intermediate firing shaft 150222 into the spine 150210. Once theintermediate firing shaft 150222 has been inserted therein, a top framesegment 150215 may be engaged with the shaft frame 150212 to enclose theintermediate firing shaft 150222 and knife bar 150280 therein. Operationof the firing member 150220 may be found in U.S. Patent ApplicationPublication No. 2014/0263541. A spine 150210 can be configured toslidably support a firing member 150220 and the closure tube 150260 thatextends around the spine 150210. The spine 150210 may slidably supportan articulation driver 150230.

The interchangeable shaft assembly 150200 can include a clutch assembly150400 configured to selectively and releasably couple the articulationdriver 150230 to the firing member 150220. The clutch assembly 150400includes a lock collar, or lock sleeve 150402, positioned around thefiring member 150220 wherein the lock sleeve 150402 can be rotatedbetween an engaged position in which the lock sleeve 150402 couples thearticulation driver 150230 to the firing member 150220 and a disengagedposition in which the articulation driver 150230 is not operably coupledto the firing member 150220. When the lock sleeve 150402 is in theengaged position, distal movement of the firing member 150220 can movethe articulation driver 150230 distally and, correspondingly, proximalmovement of the firing member 150220 can move the articulation driver150230 proximally. When the lock sleeve 150402 is in the disengagedposition, movement of the firing member 150220 is not transmitted to thearticulation driver 150230 and, as a result, the firing member 150220can move independently of the articulation driver 150230. The nozzle150201 may be employed to operably engage and disengage the articulationdrive system with the firing drive system in the various mannersdescribed in U.S. Patent Application Publication No. 2014/0263541.

The interchangeable shaft assembly 150200 can comprise a slip ringassembly 150600, which can be configured to conduct electrical power toand/or from the end effector 150300 and/or communicate signals to and/orfrom the end effector 150300, for example. The slip ring assembly 150600can comprise a proximal connector flange 150604 and a distal connectorflange 150601 positioned within a slot defined in the nozzle portions150202, 150203. The proximal connector flange 150604 can comprise afirst face, and the distal connector flange 150601 can comprise a secondface positioned adjacent to and movable relative to the first face. Thedistal connector flange 150601 can rotate relative to the proximalconnector flange 150604 about the shaft axis SA-SA (FIG. 34 ). Theproximal connector flange 150604 can comprise a plurality of concentric,or at least substantially concentric, conductors 150602 defined in thefirst face thereof. A connector 150607 can be mounted on the proximalside of the distal connector flange 150601 and may have a plurality ofcontacts wherein each contact corresponds to and is in electricalcontact with one of the conductors 150602. Such an arrangement permitsrelative rotation between the proximal connector flange 150604 and thedistal connector flange 150601 while maintaining electrical contacttherebetween. The proximal connector flange 150604 can include anelectrical connector 150606 that can place the conductors 150602 insignal communication with a shaft circuit board, for example. In atleast one instance, a wiring harness comprising a plurality ofconductors can extend between the electrical connector 150606 and theshaft circuit board. The electrical connector 150606 may extendproximally through a connector opening defined in the chassis mountingflange. U.S. Patent Application Publication No. 2014/0263551, titledSTAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, is incorporated hereinby reference in its entirety. U.S. Patent Application Publication No.2014/0263552, titled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, isincorporated by reference in its entirety. Further details regardingslip ring assembly 150600 may be found in U.S. Patent ApplicationPublication No. 2014/0263541.

The interchangeable shaft assembly 150200 can include a proximal portionfixably mounted to the handle assembly 150014 and a distal portion thatis rotatable about a longitudinal axis. The rotatable distal shaftportion can be rotated relative to the proximal portion about the slipring assembly 150600. The distal connector flange 150601 of the slipring assembly 150600 can be positioned within the rotatable distal shaftportion.

FIG. 37 is an exploded view of one aspect of an end effector 150300 ofthe surgical instrument 150010 of FIG. 34 , in accordance with at leastone aspect of the present disclosure. The end effector 150300 mayinclude the anvil 150306 and the surgical staple cartridge 150304. Theanvil 150306 may be coupled to an elongated channel 150302. Apertures150199 can be defined in the elongated channel 150302 to receive pins150152 extending from the anvil 150306 to allow the anvil 150306 topivot from an open position to a closed position relative to theelongated channel 150302 and surgical staple cartridge 150304. A firingbar 150172 is configured to longitudinally translate into the endeffector 150300. The firing bar 150172 may be constructed from one solidsection or may include a laminate material comprising a stack of steelplates. The firing bar 150172 comprises an I-beam 150178 and a cuttingedge 150182 at a distal end thereof. A distally projecting end of thefiring bar 150172 can be attached to the I-beam 150178 to assist inspacing the anvil 150306 from a surgical staple cartridge 150304positioned in the elongated channel 150302 when the anvil 150306 is in aclosed position. The I-beam 150178 may include a sharpened cutting edge150182 to sever tissue as the I-beam 150178 is advanced distally by thefiring bar 150172. In operation, the I-beam 150178 may fire the surgicalstaple cartridge 150304. The surgical staple cartridge 150304 caninclude a molded cartridge body 150194 that holds a plurality of staples150191 resting upon staple drivers 150192 within respective upwardlyopen staple cavities 150195. A wedge sled 150190 is driven distally bythe I-beam 150178, sliding upon a cartridge tray 150196 of the surgicalstaple cartridge 150304. The wedge sled 150190 upwardly cams the stapledrivers 150192 to force out the staples 150191 into deforming contactwith the anvil 150306 while the cutting edge 150182 of the I-beam 150178severs clamped tissue.

The I-beam 150178 can include upper pins 150180 that engage the anvil150306 during firing. The I-beam 150178 may include middle pins 150184and a bottom foot 150186 to engage portions of the cartridge body150194, cartridge tray 150196, and elongated channel 150302. When asurgical staple cartridge 150304 is positioned within the elongatedchannel 150302, a slot 150193 defined in the cartridge body 150194 canbe aligned with a longitudinal slot 150197 defined in the cartridge tray150196 and a slot 150189 defined in the elongated channel 150302. Inuse, the I-beam 150178 can slide through the aligned longitudinal slots150193, 150197, and 150189 wherein, as indicated in FIG. 24 , the bottomfoot 150186 of the I-beam 150178 can engage a groove running along thebottom surface of elongated channel 150302 along the length of slot150189, the middle pins 150184 can engage the top surfaces of cartridgetray 150196 along the length of longitudinal slot 150197, and the upperpins 150180 can engage the anvil 150306. The I-beam 150178 can space, orlimit the relative movement between, the anvil 150306 and the surgicalstaple cartridge 150304 as the firing bar 150172 is advanced distally tofire the staples from the surgical staple cartridge 150304 and/or incisethe tissue captured between the anvil 150306 and the surgical staplecartridge 150304. The firing bar 150172 and the I-beam 150178 can beretracted proximally, allowing the anvil 150306 to be opened to releasethe two stapled and severed tissue portions.

FIGS. 38A and 38B are a block diagram of a control circuit 150700 of thesurgical instrument 150010 of FIG. 34 spanning two drawing sheets, inaccordance with at least one aspect of the present disclosure. Referringprimarily to FIGS. 38A and 38B, a handle assembly 150702 may include amotor 150714, which can be controlled by a motor driver 150715 and canbe employed by the firing system of the surgical instrument 150010. Invarious forms, the motor 150714 may be a DC brushed driving motor havinga maximum rotational speed of approximately 25,000 RPM. In otherarrangements, the motor 150714 may include a brushless motor, a cordlessmotor, a synchronous motor, a stepper motor, or any other suitableelectric motor. The motor driver 150715 may comprise an H-Bridge drivercomprising FETs 150719, for example. The motor 150714 can be powered bythe power assembly 150706 releasably mounted to the handle assembly150200 for supplying control power to the surgical instrument 150010.The power assembly 150706 may comprise a battery that may include anumber of battery cells connected in series that can be used as thepower source to power the surgical instrument 150010. In certaincircumstances, the battery cells of the power assembly 150706 may bereplaceable and/or rechargeable. In at least one example, the batterycells can be LI batteries, which can be separably couplable to the powerassembly 150706.

The shaft assembly 150704 may include a shaft assembly controller150722, which can communicate with a safety controller and powermanagement controller 150716 through an interface while the shaftassembly 150704 and the power assembly 150706 are coupled to the handleassembly 150702. For example, the interface may comprise a firstinterface portion 150725, which may include one or more electricconnectors for coupling engagement with corresponding shaft assemblyelectric connectors, and a second interface portion 150727, which mayinclude one or more electric connectors for coupling engagement withcorresponding power assembly electric connectors to permit electricalcommunication between the shaft assembly controller 150722 and the powermanagement controller 150716 while the shaft assembly 150704 and thepower assembly 150706 are coupled to the handle assembly 150702. One ormore communication signals can be transmitted through the interface tocommunicate one or more of the power requirements of the attachedinterchangeable shaft assembly 150704 to the power management controller150716. In response, the power management controller may modulate thepower output of the battery of the power assembly 150706, as describedbelow in greater detail, in accordance with the power requirements ofthe attached shaft assembly 150704. The connectors may comprise switchesthat can be activated after mechanical coupling engagement of the handleassembly 150702 to the shaft assembly 150704 and/or to the powerassembly 150706 to allow electrical communication between the shaftassembly controller 150722 and the power management controller 150716.

The interface can facilitate transmission of the one or morecommunication signals between the power management controller 150716 andthe shaft assembly controller 150722 by routing such communicationsignals through a main controller 150717 residing in the handle assembly150702, for example. In other circumstances, the interface canfacilitate a direct line of communication between the power managementcontroller 150716 and the shaft assembly controller 150722 through thehandle assembly 150702 while the shaft assembly 150704 and the powerassembly 150706 are coupled to the handle assembly 150702.

The main controller 150717 may be any single core or multicoreprocessor, such as those known under the trade name ARM Cortex by TexasInstruments. In one aspect, the main controller 150717 may be anLM4F230H5QR ARM Cortex-M4F Processor Core, available from TexasInstruments, for example, comprising on-chip memory of 256 KBsingle-cycle flash memory, or other non-volatile memory, up to 40 MHz, aprefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, internal ROM loaded with StellarisWare® software, 2KB EEPROM, one or more PWM modules, one or more QEI analog, or one ormore 12-bit ADCs with 12 analog input channels, details of which areavailable for the product datasheet.

The safety controller may be a safety controller platform comprising twocontroller-based families, such as TMS570 and RM4x, known under thetrade name Hercules ARM Cortex R4, also by Texas Instruments. The safetycontroller may be configured specifically for IEC 61508 and ISO 26262safety critical applications, among others, to provide advancedintegrated safety features while delivering scalable performance,connectivity, and memory options.

The power assembly 150706 may include a power management circuit thatmay comprise the power management controller 150716, a power modulator150738, and a current sensor circuit 150736. The power managementcircuit can be configured to modulate power output of the battery basedon the power requirements of the shaft assembly 150704 while the shaftassembly 150704 and the power assembly 150706 are coupled to the handleassembly 150702. The power management controller 150716 can beprogrammed to control the power modulator 150738 of the power output ofthe power assembly 150706 and the current sensor circuit 150736 can beemployed to monitor power output of the power assembly 150706 to providefeedback to the power management controller 150716 about the poweroutput of the battery so that the power management controller 150716 mayadjust the power output of the power assembly 150706 to maintain adesired output. The power management controller 150716 and/or the shaftassembly controller 150722 each may comprise one or more processorsand/or memory units that may store a number of software modules.

The surgical instrument 150010 (FIGS. 34-37 ) may comprise an outputdevice 150742, which may include devices for providing a sensoryfeedback to a user. Such devices may comprise, for example, visualfeedback devices (e.g., a liquid-crystal display (LCD) screen, LEDindicators), audio feedback devices (e.g., a speaker, a buzzer), ortactile feedback devices (e.g., haptic actuators). In certaincircumstances, the output device 150742 may comprise a display 150743,which may be included in the handle assembly 150702. The shaft assemblycontroller 150722 and/or the power management controller 150716 canprovide feedback to a user of the surgical instrument 150010 through theoutput device 150742. The interface can be configured to connect theshaft assembly controller 150722 and/or the power management controller150716 to the output device 150742. The output device 150742 can insteadbe integrated with the power assembly 150706. In such circumstances,communication between the output device 150742 and the shaft assemblycontroller 150722 may be accomplished through the interface while theshaft assembly 150704 is coupled to the handle assembly 150702.

The control circuit 150700 comprises circuit segments configured tocontrol operations of the powered surgical instrument 150010. A safetycontroller segment (Segment 1) comprises a safety controller and themain controller 150717 segment (Segment 2). The safety controller and/orthe main controller 150717 are configured to interact with one or moreadditional circuit segments, such as an acceleration segment, a displaysegment, a shaft segment, an encoder segment, a motor segment, and apower segment. Each of the circuit segments may be coupled to the safetycontroller and/or the main controller 150717. The main controller 150717is also coupled to a flash memory. The main controller 150717 alsocomprises a serial communication interface. The main controller 150717comprises a plurality of inputs coupled to, for example, one or morecircuit segments, a battery, and/or a plurality of switches. Thesegmented circuit may be implemented by any suitable circuit, such as,for example, a printed circuit board assembly (PCBA) within the poweredsurgical instrument 150010. It should be understood that the termprocessor as used herein includes any microprocessor, processors,controller, controllers, or other basic computing device thatincorporates the functions of a computer's CPU on an integrated circuitor, at most, a few integrated circuits. The main controller 150717 is amultipurpose, programmable device that accepts digital data as input,processes it according to instructions stored in its memory, andprovides results as output. It is an example of sequential digitallogic, as it has internal memory. The control circuit 150700 can beconfigured to implement one or more of the processes described herein.

The acceleration segment (Segment 3) comprises an accelerometer. Theaccelerometer is configured to detect movement or acceleration of thepowered surgical instrument 150010. Input from the accelerometer may beused to transition to and from a sleep mode, identify an orientation ofthe powered surgical instrument, and/or identify when the surgicalinstrument has been dropped. In some examples, the acceleration segmentis coupled to the safety controller and/or the main controller 150717.

The display segment (Segment 4) comprises a display connector coupled tothe main controller 150717. The display connector couples the maincontroller 150717 to a display through one or more integrated circuitdrivers of the display. The integrated circuit drivers of the displaymay be integrated with the display and/or may be located separately fromthe display. The display may comprise any suitable display, such as, forexample, an organic light-emitting diode (OLED) display, an LCD, and/orany other suitable display. In some examples, the display segment iscoupled to the safety controller.

The shaft segment (Segment 5) comprises controls for an interchangeableshaft assembly 150200 (FIGS. 34 and 36 ) coupled to the surgicalinstrument 150010 (FIGS. 34-37 ) and/or one or more controls for an endeffector 150300 coupled to the interchangeable shaft assembly 150200.The shaft segment comprises a shaft connector configured to couple themain controller 150717 to a shaft PCBA. The shaft PCBA comprises alow-power microcontroller with a ferroelectric random access memory(FRAM), an articulation switch, a shaft release Hall-effect switch, anda shaft PCBA EEPROM. The shaft PCBA EEPROM comprises one or moreparameters, routines, and/or programs specific to the interchangeableshaft assembly 150200 and/or the shaft PCBA. The shaft PCBA may becoupled to the interchangeable shaft assembly 150200 and/or integralwith the surgical instrument 150010. In some examples, the shaft segmentcomprises a second shaft EEPROM. The second shaft EEPROM comprises aplurality of algorithms, routines, parameters, and/or other datacorresponding to one or more shaft assemblies 150200 and/or endeffectors 150300 that may be interfaced with the powered surgicalinstrument 150010.

The position encoder segment (Segment 6) comprises one or more magneticangle rotary position encoders. The one or more magnetic angle rotaryposition encoders are configured to identify the rotational position ofthe motor 150714, an interchangeable shaft assembly 150200 (FIGS. 34 and36 ), and/or an end effector 150300 of the surgical instrument 150010(FIGS. 34-37 ). In some examples, the magnetic angle rotary positionencoders may be coupled to the safety controller and/or the maincontroller 150717.

The motor circuit segment (Segment 7) comprises a motor 150714configured to control movements of the powered surgical instrument150010 (FIGS. 34-37 ). The motor 150714 is coupled to the mainmicrocontroller processor 150717 by an H-bridge driver comprising one ormore H-bridge FETs and a motor controller. The H-bridge driver is alsocoupled to the safety controller. A motor current sensor is coupled inseries with the motor to measure the current draw of the motor. Themotor current sensor is in signal communication with the main controller150717 and/or the safety controller. In some examples, the motor 150714is coupled to a motor electromagnetic interference (EMI) filter.

The motor controller controls a first motor flag and a second motor flagto indicate the status and position of the motor 150714 to the maincontroller 150717. The main controller 150717 provides a PWM highsignal, a PWM low signal, a direction signal, a synchronize signal, anda motor reset signal to the motor controller through a buffer. The powersegment is configured to provide a segment voltage to each of thecircuit segments.

The power segment (Segment 8) comprises a battery coupled to the safetycontroller, the main controller 150717, and additional circuit segments.The battery is coupled to the segmented circuit by a battery connectorand a current sensor. The current sensor is configured to measure thetotal current draw of the segmented circuit. In some examples, one ormore voltage converters are configured to provide predetermined voltagevalues to one or more circuit segments. For example, in some examples,the segmented circuit may comprise 3.3V voltage converters and/or 5Vvoltage converters. A boost converter is configured to provide a boostvoltage up to a predetermined amount, such as, for example, up to 13V.The boost converter is configured to provide additional voltage and/orcurrent during power-intensive operations and prevent brownout orlow-power conditions.

A plurality of switches are coupled to the safety controller and/or themain controller 150717. The switches may be configured to controloperations of the surgical instrument 150010 (FIGS. 34-37 ), of thesegmented circuit, and/or indicate a status of the surgical instrument150010. A bail-out door switch and Hall-effect switch for bailout areconfigured to indicate the status of a bail-out door. A plurality ofarticulation switches, such as, for example, a left-side articulationleft switch, a left-side articulation right switch, a left-sidearticulation center switch, a right-side articulation left switch, aright-side articulation right switch, and a right-side articulationcenter switch are configured to control articulation of aninterchangeable shaft assembly 150200 (FIGS. 34 and 36 ) and/or the endeffector 150300 (FIGS. 34-37 ). A left-side reverse switch and aright-side reverse switch are coupled to the main controller 150717. Theleft-side switches comprising the left-side articulation left switch,the left-side articulation right switch, the left-side articulationcenter switch, and the left-side reverse switch are coupled to the maincontroller 150717 by a left flex connector. The right-side switchescomprising the right-side articulation left switch, the right-sidearticulation right switch, the right-side articulation center switch,and the right-side reverse switch are coupled to the main controller150717 by a right flex connector. A firing switch, a clamp releaseswitch, and a shaft engaged switch are coupled to the main controller150717.

Any suitable mechanical, electromechanical, or solid state switches maybe employed to implement the plurality of switches, in any combination.For example, the switches may be limit switches operated by the motionof components associated with the surgical instrument 150010 (FIGS.34-37 ) or the presence of an object. Such switches may be employed tocontrol various functions associated with the surgical instrument150010. A limit switch is an electromechanical device that consists ofan actuator mechanically linked to a set of contacts. When an objectcomes into contact with the actuator, the device operates the contactsto make or break an electrical connection. Limit switches are used in avariety of applications and environments because of their ruggedness,ease of installation, and reliability of operation. They can determinethe presence or absence, passing, positioning, and end of travel of anobject. In other implementations, the switches may be solid stateswitches that operate under the influence of a magnetic field, such asHall-effect devices, MR devices, GMR devices, and magnetometers, amongothers. In other implementations, the switches may be solid stateswitches that operate under the influence of light, such as opticalsensors, IR sensors, and ultraviolet sensors, among others. Still, theswitches may be solid state devices such as transistors (e.g., FET,Junction-FET, MOSFET, bipolar, and the like). Other switches may includewireless switches, ultrasonic switches, accelerometers, and inertialsensors, among others.

FIG. 39 is another block diagram of the control circuit 150700 of thesurgical instrument of FIG. 34 illustrating interfaces between thehandle assembly 150702 and the power assembly 150706 and between thehandle assembly 150702 and the interchangeable shaft assembly 150704, inaccordance with at least one aspect of the present disclosure. Thehandle assembly 150702 may comprise a main controller 150717, a shaftassembly connector 150726, and a power assembly connector 150730. Thepower assembly 150706 may include a power assembly connector 150732, apower management circuit 150734 that may comprise the power managementcontroller 150716, a power modulator 150738, and a current sensorcircuit 150736. The shaft assembly connectors 150730, 150732 form aninterface 150727. The power management circuit 150734 can be configuredto modulate power output of the battery 150707 based on the powerrequirements of the interchangeable shaft assembly 150704, while theinterchangeable shaft assembly 150704 and the power assembly 150706 arecoupled to the handle assembly 150702. The power management controller150716 can be programmed to control the power modulator 150738 of thepower output of the power assembly 150706, and the current sensorcircuit 150736 can be employed to monitor power output of the powerassembly 150706 to provide feedback to the power management controller150716 about the power output of the battery 150707 so that the powermanagement controller 150716 may adjust the power output of the powerassembly 150706 to maintain a desired output. The shaft assembly 150704comprises a shaft processor 150720 coupled to a non-volatile memory150721 and shaft assembly connector 150728 to electrically couple theshaft assembly 150704 to the handle assembly 150702. The shaft assemblyconnectors 150726, 150728 form interface 150725. The main controller150717, the shaft processor 150720, and/or the power managementcontroller 150716 can be configured to implement one or more of theprocesses described herein.

The surgical instrument 150010 (FIGS. 34-37 ) may comprise an outputdevice 150742 to a sensory feedback to a user. Such devices may comprisevisual feedback devices (e.g., an LCD display screen, LED indicators),audio feedback devices (e.g., a speaker, a buzzer), or tactile feedbackdevices (e.g., haptic actuators). In certain circumstances, the outputdevice 150742 may comprise a display 150743 that may be included in thehandle assembly 150702. The shaft assembly controller 150722 and/or thepower management controller 150716 can provide feedback to a user of thesurgical instrument 150010 through the output device 150742. Theinterface 150727 can be configured to connect the shaft assemblycontroller 150722 and/or the power management controller 150716 to theoutput device 150742. The output device 150742 can be integrated withthe power assembly 150706. Communication between the output device150742 and the shaft assembly controller 150722 may be accomplishedthrough the interface 150725 while the interchangeable shaft assembly150704 is coupled to the handle assembly 150702.

Tissue Marking

In various surgical procedures, surgical instruments seal tissue byapplication of energy or deployment of staples into the tissue. Thesurgical instruments may also sever or cut the sealed tissue. In asurgical procedure, one or more surgical instruments can be applied toseveral discrete tissue portions of a tissue being treated if the tissuesize is greater than a maximum tissue size that can be handled by asurgical instrument in a single application. If a leak occurs in one ofthe treated tissue portions, it can be difficult to identify a surgicalinstrument, or a component thereof such as a staple cartridge, that wasinvolved. Without such identification, it becomes difficult to determinethe cause of the leak.

Aspects of the present disclosure present a surgical instrument thatincludes an end effector configured to apply a tissue treatment totissue. The end effector includes a first jaw, a second jaw movablerelative to the first jaw to grasp tissue therebetween, and atissue-treatment mechanism configured to apply a tissue treatment totissue grasped between the first jaw and the second jaw. In addition,the surgical instrument includes a marking assembly configured to applya distinct marking to the tissue unique to each tissue treatmentapplication, wherein the distinct marking distinguishes the tissuetreatment application from other tissue treatment applications performedby the surgical instrument or other surgical instruments.

In various aspects, the tissue treatment mechanism comprises a staplecartridge configured to apply a tissue treatment application bydeploying staples into tissue grasped by an end effector. In otheraspects, the tissue treatment mechanism comprises an energy deviceconfigured to apply a tissue treatment application by deliveringtherapeutic energy to tissue grasped by an end effector. The energydelivered by the energy device can be in the form of RF energy orultrasonic energy, for example.

In various aspects, the tissue treatment mechanism comprises atransection member movable to apply tissue treatment application bytransecting the grasped tissue. One or both of the jaws of the endeffector may include longitudinal slots configured to accommodate thetransection member. The transection member may include a cutting edge ata distal portion thereof.

FIG. 40 illustrates a logic flow diagram of a process 31010 depicting acontrol program or a logic configuration for marking tissue treated byan end effector of a surgical instrument, in accordance with at leastone aspect of the present disclosure. In one aspect, as described ingreater detail below, the process 31010 is executed by a control circuit500 (FIG. 13 ). In another aspect, the process 31010 can be executed bya combinational logic circuit 510 (FIG. 14 ). In yet another aspect, theprocess 31010 can be executed by a sequential logic circuit 520 (FIG. 15).

In the example of FIGS. 41-44 , tissue is treated by an end effector31000 of a surgical stapling and cutting instrument 31006 and is markedby a marking assembly 31020 of a control system 31470.

The surgical instrument 31006 is similar in many respects to thesurgical instrument 150010. For example, the end effector 31000 and thecontrol system 31470 are similar in many respects to the end effector150300 and the control circuit 470 (FIG. 12 ), respectively. Componentsof the surgical instrument 31006 that are similar to above-describedcomponents of the surgical instrument 150010 are not repeated herein indetail for conciseness.

The end effector 31000 includes a first jaw 31001 and a second jaw 31002extending from an interchangeable shaft assembly 150200. The endeffector 31000 further includes an anvil defined in the first jaw 31001and a staple cartridge 31005 defined in the second jaw 31002. At leastone of the first jaw 31001 and the second jaw 31002 is movable relativeto the other to transition the end effector 26000 between an openconfiguration and a closed configuration to grasp tissue between theanvil and the staple cartridge 31005. In operation, a tissue treatmentby the surgical instrument 31006 involves deploying staples from thestaple cartridge 26005 by a firing member into the grasped tissue. Thedeployed staples are deformed by the anvil. In various aspects, thetissue can also be treated by transection using a cutting member movablerelative to a longitudinal slot 31007 defined in at least one of thefirst jaw 31001 and the second jaw 31002.

In various aspects, a surgical instrument, in accordance with thepresent disclosure, may include an end effector that treats tissue byapplication of RF or ultrasonic energy to tissue. In various aspects,the surgical instrument 26010 can be a handheld surgical instrument.Alternatively, the surgical instrument 26010 can be incorporated into arobotic system as a component of a robotic arm. Additional details onrobotic systems are disclosed in U.S. Provisional Patent Application No.62/611,339, filed Dec. 28, 2017, which is incorporated herein byreference in its entirety.

Referring again to FIG. 40 , the process 31010 includes receiving 31011sensor signals indicative of application of a tissue treatment. If it isdetermined 31012, based on the received sensor signals, that a tissuetreatment has been, or is being, applied to the tissue, a distinctmarking is applied 31013 to the tissue. The distinct marking is uniqueto the tissue treatment application and can be utilized to distinguishthe tissue treatment application from other tissue treatmentapplications.

Referring to FIG. 44 , in various aspects, the process 31010 can beperformed by a control system 31470 of the surgical instrument 31006.The control system 31470 is similar in many respects to the controlsystem 470 (FIG. 12 ). For example, the control system 31470 includes acontrol circuit that has a microcontroller 470. A number of sensors 472,474, 476, 31473 provide various sensor signals to the microcontroller470. One or more of such sensor signals can be analyzed alone, or incombination with other sensor signals, to determine whether a tissuetreatment has been, or is being, applied to tissue. The control system31470 further includes a marking assembly 31020 in communication withthe microcontroller 470. After determining that a tissue treatment hasbeen, or is being, applied to tissue, the microcontroller 470 causes themarking assembly 31020 to mark the tissue.

In various instances, the marking of the tissue by the marking assembly31020 can be triggered by input from an operator of the surgicalinstrument 31006, which can be delivered through a user interface suchas, for example, the display 473. Alternatively, or in addition, themarking of the tissue can be triggered by one or more sensor signals.

In one example, readings from the strain gauge sensor 474, which can beused to measure the force applied to tissue grasped by the end effector31000, can trigger the tissue marking. The microcontroller 461, uponreceipt of a sensor signal from the sensor 474 beyond a predeterminedthreshold, which indicates that tissue is grasped by the end effector31000, may cause the marking assembly 31020 to mark the tissue.

In one example, readings from an activation sensor 31473, which can beused to detect deployment of staples or energy application to tissue,can trigger the tissue marking. The microcontroller 461, upon receipt ofa sensor signal from the sensor 31473 beyond a predetermined threshold,may instruct the marking assembly 31020 to mark the tissue.

In the example of FIGS. 41 and 43 , the marking assembly 31020 includestwo marking applicators 31021, 31022 disposed on the second jaw 31002.More specifically, the applicator 31021 is disposed on a proximalportion 31008 of a staple cartridge 31005 assembled with the second jaw31002, while the applicator 31022 is disposed on a distal portion 31009of the staple cartridge 31005. In other arrangements, more or less thantwo applicators can be disposed onto one or more jaws of an end effectorto apply markings to tissue treated by the end effector.

Each of the applicators 31021, 31022 includes markers 31023, which arearranged in a predetermined pattern. As illustrated in FIG. 44 , themarkers 31023 of the applicators 31021, 31022 are arranged in threerows. Also, the applicators 31021, 31022 comprise the same number andarrangement of markers 31023. In certain instances, however, the markersof an applicator can be arranged in any suitable arrangement. Differentapplicators may comprise the same or different marker arrangements. Incertain instances, all of the markers of an applicator are activated togenerate a tissue marking. In other instances, only some of the markersof an applicator are activated to generate a tissue marking. Theactivation of the markers can be controlled by the microcontroller 461to yield a predetermined marking.

In various instances, the markers 31023 can be configured to apply theirindividual marks at the same intensity. Alternatively, the markers 31023can be configured to apply their individual marks at differentintensities. The intensity of the marks can be controlled by themicrocontroller 461 to yield a predetermined marking.

In various instances, as illustrated in FIG. 41 , the applicators 31021,31022 are arranged at proximal and distal portions 31008, 31009,respectively, of the second jaw 31002. This arrangement allows theapplicators 31021, 31022 to apply their markings proximal and distal toa tissue treatment, which can assist in identifying the beginning andend of the tissue treatment.

In various instances, one or more of the markings are detectable throughstimulation by at least one of a light source, a radiation source, andan illumination source. In certain instances, the markers 31023 areconfigured to apply one or more fluorescent materials to the tissuecausing the markings to be visible only in the presence of a lightsource outside of the visible spectrum. In other words, the markingswill fluoresce under an applied light source outside of the visiblespectrum.

In certain instances, the makers 31023 are configured to use an IRreadable ink formulation in generating the markings. The ink formulationcan be based on absorption and reflection of light in the IR. Asillustrated in FIG. 45 , the markers 31023 can be configured to generateunique IR ink markings 31035, 31037.

In certain instances, the markers 31023 are in the form of electrodesthat are selectively activatable by the microcontroller 461 to generatethe markings. The microcontroller 461 may control the intensity of eachmark by controlling the activation time of the electrodes. The longer anelectrode is activated, the greater the intensity of the mark.Segmentation can be introduced within the electrodes to leave adistinctive marking. In certain instances, the markers 31023 can beequipped with RF electrodes, including a series of micro electrodesconfigured to weld an optically identifiable distinct marking for eachapplication of a tissue treatment.

Referring to FIGS. 42 and 45 , eight tissue portions received eighttreatments performed by an end effector 31030 of a surgical instrument31036. FIG. 43 depicts a jaw 31002 of the end effector 31030. In each ofthe eight treatments, the end effector 31030 grasped a tissue portion,sealed the tissue portion, and cut the tissue portion. The treatmentswere applied in a particular order, as illustrated in FIG. 45 , toseparate a cancerous portion of the colon from neighboring tissue T. Amarking assembly 31033, which includes applicators 31031, 31032, applieddistinct tissue markings to each tissue portion with each treatment.

The surgical instrument 31036 is similar in many respects to thesurgical instruments 31006, 150010. For example, the end effector 31000is similar in many respects to the end effectors 31000, 150300.Components of the surgical instrument 31036 that are similar toabove-described components of the surgical instruments 31006, 150010 arenot repeated herein in detail for conciseness.

In the example of FIG. 42 , the applicators 31031, 31032 are disposed ata proximal portion 31009 of a second jaw 31034 on opposite sides 31038,31039 of a transection path defined by the longitudinal slot 31007 alonga longitudinal axis LA. In this arrangement, each side of the transectedtissue receives a distinct marking.

In various instances, as illustrated in FIG. 45 , the marking could bemade in such an order that the sequence of the marks from one use to thenext provides a distinct marking for a sequence of consecutivetreatments. This would allow a unique marking over a series oftreatments in addition to the markings associated with individualtreatments. Said another way, the markings associated with relatedtreatments may include a common identifier in addition to their uniqueidentifiers. Treatments can be related by virtue of being firedconsecutively in a surgical procedure or by a single surgicalinstrument.

In various aspects, the surgical instruments of the present disclosuresuch as, for example, the surgical instruments 26010, 31006, 310036 arecommunicatively coupled to a surgical hub (e.g., surgical hubs 106 (FIG.2 , FIG. 3 ), 206 (FIG. 10 )) through a wired and/or wirelesscommunication channels. Data gathered by such surgical instruments canbe transmitted to the surgical hub 106, 206, which may further transmitthe data to a cloud-based system (e.g., cloud-based systems 104, 204),for additional analysis.

Further to the above, a visualization system (e.g., visualizationsystems 108 (FIG. 3 ), 208 (FIG. 9 )), may record frames of the markedtissue for subsequent identification after a surgical instrument ismoved from a surgical site. The data from the surgical instrument andthe frames recorded by a visualization system and can be transmitted toa surgical hub, which may time stamp and/or correlate the data receivedfrom both sources. The data can also be forwarded to the cloud-basedsystem for additional analysis.

This process can be helpful in analyzing failures. For example, asillustrated in FIG. 45 , a leak 31039 has occurred at the seventh tissuetreatment. The distinct marking at the seventh tissue treatment, whichis recorded by the visualization system, will help identify the surgicalinstrument that performed the seventh treatment. Accordingly, theoperational data 31040 at the seventh treatment can be examined andcompared to operational data 31042 of the same surgical instrumentwithin the same environment that yielded successful application ofsimilar treatments. As described above, the markings of a singlesurgical procedure or those created by a single surgical instrument mayinclude a common identifier allowing for a quick comparison of theoperational data 31040 and the operational data 31042.

In the example of FIG. 45 , the operation data at the first tissuetreatment application, which yielded a successful seal, is compared tothe operational data at the seventh tissue treatment application, whichyielded the leak. In comparing the two data sets, it becomes clear thatthe leak was caused by an unusual drop in clamp force, which can beaddressed in subsequent tissue treatments with the same or similarsurgical instruments. In other instances, the operational data of thesurgical instrument associated with a failure are compared to presetstandards.

In certain instances, the above-described failure analysis can beperformed by a surgical hub in real time during a surgical procedure.Leak detection and deciphering tissue marking can be performed byvarious image processing techniques. The surgical operator can be guidedback to the surgical site with the aid of the surgical hub by identifyanatomical landmarks and the inherent variable shading of the tissuesusing a dot-by-dot analysis technique. In certain instances, landmarkscan be identified and acquired by observing hot spots in tissue afterenergy application.

Data Transmission Prioritization

Various data can be gathered and/or generated by a powered surgicalinstrument during a surgical procedure. For example, a powered surgicalstapling and cutting instrument may collect, among other things,force-to-clamp (FTC) and force-to-fire (FTF) readings, which can betransmitted to a surgical hub that further transmits the data to acloud-based system for additional processing. A communication pathwaybetween the powered surgical instrument and the surgical hub has apredetermined bandwidth. Likewise, a communication pathway between thesurgical hub and the cloud-based system also has a predeterminedbandwidth. In certain instances, various environmental interferences mayfurther limit such bandwidths. Moreover, various data sources maycompete for the limited bandwidths.

During a surgical procedure, a surgical hub may react to the receiveddata by adjusting various parameters at its control in real time.Depending on the surgical step being performed, certain data sourcesand/or surgical activities become more important than others.Transmitting the data without considering its importance may interferewith operation of the surgical hub and its ability to make timelydecisions. Likewise, a delay in data transmission due to bandwidthlimits may interfere with operation of the surgical hub and its abilityto make timely decisions.

In various aspects, a surgical system 32002 is used in a surgicalprocedure. The surgical system 32002 includes a surgical hub (e.g.,surgical hub 106 (FIG. 3 , FIG. 4 , FIG. 49 ), surgical hub 206 (FIG. 10)), a powered surgical instrument (e.g., Device/Instrument 235 (FIG. 9), surgical instrument 32235 (FIG. 49 )), and a communication module32004 (FIG. 49 ). The communication module 32004 includes ashift/register 32005 and a transceiver 32007.

FIG. 48 illustrates a logic flow diagram of a process 32000 depicting acontrol program or a logic configuration for coordinating transmissionof data between the powered surgical instrument 32235 and a surgical hub(e.g., surgical hub 106 (FIG. 3 , FIG. 4 , FIG. 49 ), surgical hub 206(FIG. 10 )), in accordance with at least one aspect of the presentdisclosure. The process 32000 includes receiving 32006 first dataregarding a first surgical activity of the surgical procedure, receiving32008 second data regarding a second surgical activity of the surgicalprocedure, selecting 32010 transmission rates for transmission the firstdata and the second data between the powered surgical instrument 32235and the surgical hub 106 based on at least one characteristic of atleast one of the first surgical activity and the second surgicalactivity, and transmitting 32012 the first data and the second databetween the powered surgical instrument and the surgical hub at theselected transmission rates.

In at least one example, the process 32000 selects or adjuststransmission rates for transmission of the first data and the seconddata between the powered surgical instrument 32235 and the surgical hub106 based on at least one characteristic of at least one of the firstsurgical activity and the second surgical activity and availablebandwidth. The communication module 32004 may determine availablebandwidth, which may change over time based on various factors such as,for example, interference and other environmental factors.

FIG. 49 illustrates a control system 32470 of the surgical instrument32235, which can be employed to execute the process of FIG. 48 . Thecontrol system 32470 is similar in many respects to the control system470 (FIG. 12 ). In various aspects, the process 32000 can be executed bythe communication module 32004 of the surgical instrument 32235, whichincludes a microcontroller 461 coupled to sensors 472, 474, 476, asillustrated in FIG. 49 .

In various aspects, the first data can be received from a first sourceand the second data received from a second source different than thefirst source. The first source and/or the second source may be any ofthe sensors 472, 474, 476, for example.

In various aspects, the surgical instrument 32235 is similar in manyrespects to the surgical instruments 235 (FIG. 9 ), 150010 (FIG. 35 ).For example, like the surgical instrument 150010, the surgicalinstrument 32235 includes an end effector 150300 transitionable, in afirst surgical activity, from an open configuration, as illustrated inFIG. 25 , to a closed configuration to grasp tissue. A motor 482 (FIG.49 ) may drive the transition of the end effector 150300 between theopen configuration and the closed configuration. In certain instances,the first data represent the force required to FTC the end effector150300 over time, as illustrated in FIG. 46 .

In various aspects, the surgical instrument 32235 comprises adisplacement member (e.g., drive member 150120 of FIG. 39 ) movable, inthe second surgical activity, to deploy/fire staples into the tissuegrasped by the end effector 150300. In certain instances, the seconddata represent FTF the end effector 150300 over time, as illustrated inFIG. 46 .

FIG. 46 is a graph illustrating FTC and FTF readings for the poweredsurgical instrument 32235 during a surgical procedure plotted againsttime (t). Corresponding transmission rates of the FTC and FTF readingsto a surgical hub 106 are also plotted against time (t). In the exampleof FIGS. 46 and 47 , the sensors 472, 474, 476 comprise an idealsampling rate of 30 samples per second. A sampling rate is a rate atwhich a reading is taken.

The communication channel between the powered surgical instrument 32235and the surgical hub 106 comprises a first bandwidth capable oftransmissions up to 25 Megabits per second, which corresponds to amaximum of 62 samples transmitted per second. The first bandwidth isreduced to a second bandwidth at a time t=t₂, due to environmentalinterferences within the operating room. The second bandwidth is capableof transmissions up to 20 Megabits per second, which corresponds to amaximum of 48 samples per second. FIG. 47 also lists actual FTC and FTFsamples transmitted per second at four example time points (t₁, t₂, t₃,t₄) selected for illustration purposes.

Referring again to FIGS. 46 and 47 , the first surgical activity,represented by FTC data, begins at time t=0 while the second surgicalactivity, represented by FTF data, begins at time t=t₃. The firstsurgical activity also reaches a maximum FTC, which defines an importantcharacteristic of the first surgical activity, at t=t₁. Accordingly, upto the time t=t₃, it is desirable to prioritize transmission of FTC dataassociated with the first surgical activity over FTF data associatedwith the second surgical activity. As illustrated at t=t₁, whichcorresponds to the maximum FTC values, FTC data is transmitted at anoptimal transmission rate corresponding to 30 samples per second whileno FTF data is transmitted during this initial stage.

Further to the above, a negative transition in bandwidth or maximumavailable transmission rate occurs at t=ta, and is sensed by thecommunication module 32004. In response, the transmission rate of theFTC data is lowered to a transmission rate corresponding to 26 samplesper second, as illustrated at t=t₂, in order to accommodate the negativetransition caused by the environmental interferences. In variousinstances, the first data and the second data are transmitted through acommunication channel established between the powered surgicalinstrument 32235 and the surgical hub 106, and the communication module32004 adjusts the transmission rate of at least one of the first dataand the second data in response to the change in bandwidth of thecommunication channel.

In the example of FIGS. 47 and 48 , only the FTC data transmission rateis lowered, from 30 to 26 samples per seconds because the FTF datatransmission rate is already at 0 samples per seconds. In otherinstances, an ongoing prioritization scheme, which is instituted basedon a characteristic of at least one of the first surgical activity andthe second surgical activity, may impact the effect of a negativetransition in bandwidth on the transmission rates of the first dataand/or the second data, as described in greater detail below.

At t=t₃, FTF data and FTC data become equally relevant. Due to thereduction in bandwidth or maximum available transmission rates, however,only 48 samples can be transmitted per second. Accordingly, thetransmission rates of the FTC data and the FTF data are adjusted to bethe same at 24 samples per second. In other words, the transmissionrates of the FTC data and the FTF data are adjusted to accommodate theincreased relevance of the FTF data and the negative transition inbandwidth or maximum available transmission rates.

Further to the above, as the FTF data ramps upward and the FTC datatails off, the FTF data can be prioritized over the FTC data.Accordingly, the transmission rate of the FTF data can be increased, andthe transmission rate of the FTC data decreased for the remainder of thesecond surgical activity. In other words, the communication module 32004may adjust transmission rates for transmission of the first data and thesecond data between the powered surgical instrument and the surgical hubbased on a characteristic of at least one of the first surgical activityand the second surgical activity.

At t=t₄, an irregular FTF is detected as the FTF has exceeded apredetermined threshold. To investigate the irregular FTF, thecommunication module 32004 responds by increasing the FTF datatransmission rate to 40 samples per second, while decreasing the FTCtransmission rate to 8 samples per second. In other words, thecommunication module 32004 responds to the sensed irregularity in FTFdata by adjusting the transmission rates to prioritize transmission ofFTF data over FTC data.

FIG. 50 illustrates a logic flow diagram of a process 32100 depicting acontrol program or a logic configuration for coordinating transmissionof data between the powered surgical instrument 32235 and a surgical hub(e.g., surgical hub 106 (FIG. 3 , FIG. 4 , FIG. 49 ), surgical hub 206(FIG. 10 )), in accordance with at least one aspect of the presentdisclosure. The process 32100 includes receiving 32106 first dataregarding a first surgical activity of the surgical procedure, receiving32108 second data regarding a second surgical activity of the surgicalprocedure, and transmitting 32112 the first data and the second databetween the powered surgical instrument 32235 and the surgical hub 106.

Further to the above, if an irregularity is detected 32109, the process32100 adjusts 32110 transmission rates for transmission the first dataand the second data between the powered surgical instrument 32235 andthe surgical hub 106 to prioritize transmission of the data encompassingthe irregularity. As described above, an irregularity, in accordancewith the process 32109 can be exceeding a predetermined threshold.

In various aspects, the communication module 32004 sets a preferred orprioritized communication processing arrangement to insure the flow oflow-speed data and high-speed connections while still enablingprioritization of slow bandwidth data if its need is a higher priority.

Situational Awareness

Situational awareness is the ability of some aspects of a surgicalsystem to determine or infer information related to a surgical procedurefrom data received from databases and/or instruments. The informationcan include the type of procedure being undertaken, the type of tissuebeing operated on, or the body cavity that is the subject of theprocedure. With the contextual information related to the surgicalprocedure, the surgical system can, for example, improve the manner inwhich it controls the modular devices (e.g. a robotic arm and/or roboticsurgical tool) that are connected to it and provide contextualizedinformation or suggestions to the surgeon during the course of thesurgical procedure.

Referring now to FIG. 51 , a timeline 5200 depicting situationalawareness of a hub, such as the surgical hub 106 or 206, for example, isdepicted. The timeline 5200 is an illustrative surgical procedure andthe contextual information that the surgical hub 106, 206 can derivefrom the data received from the data sources at each step in thesurgical procedure. The timeline 5200 depicts the typical steps thatwould be taken by the nurses, surgeons, and other medical personnelduring the course of a lung segmentectomy procedure, beginning withsetting up the operating theater and ending with transferring thepatient to a post-operative recovery room.

The situationally aware surgical hub 106, 206 receives data from thedata sources throughout the course of the surgical procedure, includingdata generated each time medical personnel utilize a modular device thatis paired with the surgical hub 106, 206. The surgical hub 106, 206 canreceive this data from the paired modular devices and other data sourcesand continually derive inferences (i.e., contextual information) aboutthe ongoing procedure as new data is received, such as which step of theprocedure is being performed at any given time. The situationalawareness system of the surgical hub 106, 206 is able to, for example,record data pertaining to the procedure for generating reports, verifythe steps being taken by the medical personnel, provide data or prompts(e.g., via a display screen) that may be pertinent for the particularprocedural step, adjust modular devices based on the context (e.g.,activate monitors, adjust the field of view (FOV) of the medical imagingdevice, or change the energy level of an ultrasonic surgical instrumentor RF electrosurgical instrument), and take any other such actiondescribed above.

As the first step S202 in this illustrative procedure, the hospitalstaff members retrieve the patient's EMR from the hospital's EMRdatabase. Based on select patient data in the EMR, the surgical hub 106,206 determines that the procedure to be performed is a thoracicprocedure.

Second step S204, the staff members scan the incoming medical suppliesfor the procedure. The surgical hub 106, 206 cross-references thescanned supplies with a list of supplies that are utilized in varioustypes of procedures and confirms that the mix of supplies corresponds toa thoracic procedure. Further, the surgical hub 106, 206 is also able todetermine that the procedure is not a wedge procedure (because theincoming supplies either lack certain supplies that are necessary for athoracic wedge procedure or do not otherwise correspond to a thoracicwedge procedure).

Third step S206, the medical personnel scan the patient band via ascanner that is communicably connected to the surgical hub 106, 206. Thesurgical hub 106, 206 can then confirm the patient's identity based onthe scanned data.

Fourth step S208, the medical staff turns on the auxiliary equipment.The auxiliary equipment being utilized can vary according to the type ofsurgical procedure and the techniques to be used by the surgeon, but inthis illustrative case they include a smoke evacuator, insufflator, andmedical imaging device. When activated, the auxiliary equipment that aremodular devices can automatically pair with the surgical hub 106, 206that is located within a particular vicinity of the modular devices aspart of their initialization process. The surgical hub 106, 206 can thenderive contextual information about the surgical procedure by detectingthe types of modular devices that pair with it during this pre-operativeor initialization phase. In this particular example, the surgical hub106, 206 determines that the surgical procedure is a VATS procedurebased on this particular combination of paired modular devices. Based onthe combination of the data from the patient's EMR, the list of medicalsupplies to be used in the procedure, and the type of modular devicesthat connect to the hub, the surgical hub 106, 206 can generally inferthe specific procedure that the surgical team will be performing. Oncethe surgical hub 106, 206 knows what specific procedure is beingperformed, the surgical hub 106, 206 can then retrieve the steps of thatprocedure from a memory or from the cloud and then cross-reference thedata it subsequently receives from the connected data sources (e.g.,modular devices and patient monitoring devices) to infer what step ofthe surgical procedure the surgical team is performing.

Fifth step S210, the staff members attach the EKG electrodes and otherpatient monitoring devices to the patient. The EKG electrodes and otherpatient monitoring devices are able to pair with the surgical hub 106,206. As the surgical hub 106, 206 begins receiving data from the patientmonitoring devices, the surgical hub 106, 206 thus confirms that thepatient is in the operating theater.

Sixth step S212, the medical personnel induce anesthesia in the patient.The surgical hub 106, 206 can infer that the patient is under anesthesiabased on data from the modular devices and/or patient monitoringdevices, including EKG data, blood pressure data, ventilator data, orcombinations thereof, for example. Upon completion of the sixth stepS212, the pre-operative portion of the lung segmentectomy procedure iscompleted and the operative portion begins.

Seventh step S214, the patient's lung that is being operated on iscollapsed (while ventilation is switched to the contralateral lung). Thesurgical hub 106, 206 can infer from the ventilator data that thepatient's lung has been collapsed, for example. The surgical hub 106,206 can infer that the operative portion of the procedure has commencedas it can compare the detection of the patient's lung collapsing to theexpected steps of the procedure (which can be accessed or retrievedpreviously) and thereby determine that collapsing the lung is the firstoperative step in this particular procedure.

Eighth step S216, the medical imaging device (e.g., a scope) is insertedand video from the medical imaging device is initiated. The surgical hub106, 206 receives the medical imaging device data (i.e., video or imagedata) through its connection to the medical imaging device. Upon receiptof the medical imaging device data, the surgical hub 106, 206 candetermine that the laparoscopic portion of the surgical procedure hascommenced. Further, the surgical hub 106, 206 can determine that theparticular procedure being performed is a segmentectomy, as opposed to alobectomy (note that a wedge procedure has already been discounted bythe surgical hub 106, 206 based on data received at the second step S204of the procedure). The data from the medical imaging device 124 (FIG. 2) can be utilized to determine contextual information regarding the typeof procedure being performed in a number of different ways, including bydetermining the angle at which the medical imaging device is orientedwith respect to the visualization of the patient's anatomy, monitoringthe number or medical imaging devices being utilized (i.e., that areactivated and paired with the surgical hub 106, 206), and monitoring thetypes of visualization devices utilized. For example, one technique forperforming a VATS lobectomy places the camera in the lower anteriorcorner of the patient's chest cavity above the diaphragm, whereas onetechnique for performing a VATS segmentectomy places the camera in ananterior intercostal position relative to the segmental fissure. Usingpattern recognition or machine learning techniques, for example, thesituational awareness system can be trained to recognize the positioningof the medical imaging device according to the visualization of thepatient's anatomy. As another example, one technique for performing aVATS lobectomy utilizes a single medical imaging device, whereas anothertechnique for performing a VATS segmentectomy utilizes multiple cameras.As yet another example, one technique for performing a VATSsegmentectomy utilizes an infrared light source (which can becommunicably coupled to the surgical hub as part of the visualizationsystem) to visualize the segmental fissure, which is not utilized in aVATS lobectomy. By tracking any or all of this data from the medicalimaging device, the surgical hub 106, 206 can thereby determine thespecific type of surgical procedure being performed and/or the techniquebeing used for a particular type of surgical procedure.

Ninth step S218, the surgical team begins the dissection step of theprocedure. The surgical hub 106, 206 can infer that the surgeon is inthe process of dissecting to mobilize the patient's lung because itreceives data from the RF or ultrasonic generator indicating that anenergy instrument is being fired. The surgical hub 106, 206 cancross-reference the received data with the retrieved steps of thesurgical procedure to determine that an energy instrument being fired atthis point in the process (i.e., after the completion of the previouslydiscussed steps of the procedure) corresponds to the dissection step. Incertain instances, the energy instrument can be an energy tool mountedto a robotic arm of a robotic surgical system.

Tenth step S220, the surgical team proceeds to the ligation step of theprocedure. The surgical hub 106, 206 can infer that the surgeon isligating arteries and veins because it receives data from the surgicalstapling and cutting instrument indicating that the instrument is beingfired. Similarly to the prior step, the surgical hub 106, 206 can derivethis inference by cross-referencing the receipt of data from thesurgical stapling and cutting instrument with the retrieved steps in theprocess. In certain instances, the surgical instrument can be a surgicaltool mounted to a robotic arm of a robotic surgical system.

Eleventh step S222, the segmentectomy portion of the procedure isperformed. The surgical hub 106, 206 can infer that the surgeon istransecting the parenchyma based on data from the surgical stapling andcutting instrument, including data from its cartridge. The cartridgedata can correspond to the size or type of staple being fired by theinstrument, for example. As different types of staples are utilized fordifferent types of tissues, the cartridge data can thus indicate thetype of tissue being stapled and/or transected. In this case, the typeof staple being fired is utilized for parenchyma (or other similartissue types), which allows the surgical hub 106, 206 to infer that thesegmentectomy portion of the procedure is being performed.

Twelfth step S224, the node dissection step is then performed. Thesurgical hub 106, 206 can infer that the surgical team is dissecting thenode and performing a leak test based on data received from thegenerator indicating that an RF or ultrasonic instrument is being fired.For this particular procedure, an RF or ultrasonic instrument beingutilized after parenchyma was transected corresponds to the nodedissection step, which allows the surgical hub 106, 206 to make thisinference. It should be noted that surgeons regularly switch back andforth between surgical stapling/cutting instruments and surgical energy(i.e., RF or ultrasonic) instruments depending upon the particular stepin the procedure because different instruments are better adapted forparticular tasks. Therefore, the particular sequence in which thestapling/cutting instruments and surgical energy instruments are usedcan indicate what step of the procedure the surgeon is performing.Moreover, in certain instances, robotic tools can be utilized for one ormore steps in a surgical procedure and/or handheld surgical instrumentscan be utilized for one or more steps in the surgical procedure. Thesurgeon(s) can alternate between robotic tools and handheld surgicalinstruments and/or can use the devices concurrently, for example. Uponcompletion of the twelfth step S224, the incisions are closed up and thepost-operative portion of the procedure begins.

Thirteenth step S226, the patient's anesthesia is reversed. The surgicalhub 106, 206 can infer that the patient is emerging from the anesthesiabased on the ventilator data (i.e., the patient's breathing rate beginsincreasing), for example.

Lastly, the fourteenth step S228 is that the medical personnel removethe various patient monitoring devices from the patient. The surgicalhub 106, 206 can thus infer that the patient is being transferred to arecovery room when the hub loses EKG, BP, and other data from thepatient monitoring devices. As can be seen from the description of thisillustrative procedure, the surgical hub 106, 206 can determine or inferwhen each step of a given surgical procedure is taking place accordingto data received from the various data sources that are communicablycoupled to the surgical hub 106, 206.

Situational awareness is further described in U.S. Provisional PatentApplication Ser. No. 62/611,341, titled INTERACTIVE SURGICAL PLATFORM,filed Dec. 28, 2017, which is incorporated by reference herein in itsentirety. In certain instances, operation of a robotic surgical system,including the various robotic surgical systems disclosed herein, forexample, can be controlled by the hub 106, 206 based on its situationalawareness and/or feedback from the components thereof and/or based oninformation from the cloud 104.

EXAMPLES

Various aspects of the subject matter described herein are set out inthe following numbered examples.

-   -   Example 1: A method implemented by a surgical instrument        comprising first and second jaws and a flexible circuit        comprising multiple sensors to optimize performance of a radio        frequency (RF) device, the flexible circuit comprising at least        one therapeutic electrode couplable to a source of RF energy, at        least two sensing electrodes, and at least one insulative layer,        the insulative layer is positioned between the at least one        therapeutic electrode and the at least two sensing electrodes,        the method comprising: contacting tissue positioned between the        first and second jaws of the surgical instrument with the at        least one therapeutic electrode and at the least two sensing        electrodes; sensing signals from the at the least two sensing        electrodes; and controlling RF energy delivered to the at least        one therapeutic electrode based on the sensed signals.    -   Example 2: The method of Example 1, further comprising sensing,        by the at least two sensing electrodes, impedance of the tissue        positioned between the first and second jaws of the surgical        instrument; electrical continuity of the tissue; or a        temperature transition point in the tissue; or a combination        thereof.    -   Example 3: The method of any one of Examples 1-2, further        comprising, sensing, by the at least two sensing electrodes, a        parameter associated with tissue positioned between first and        second jaws of the surgical instrument.    -   Example 4: The method of Example 4, further comprising,        adaptively controlling the RF energy delivered to the at least        one therapeutic electrode based on the parameter sensed by the        at least two sensing electrodes.    -   Example 5: A method implemented by a surgical instrument        comprising an end effector, a marking assembly, and a control        circuit, the end effector comprising a first jaw, a second jaw        movable relative to the first jaw to grasp tissue therebetween,        a plurality of sensors, and a tissue-treatment mechanism        configured to apply a tissue treatment to tissue grasped between        the first jaw and the second jaw, the method comprising:        receiving, by the control circuit, a plurality of sensor signals        from the plurality of sensors indicative of application of a        tissue treatment to the tissue; controlling, by the control        circuit, radiofrequency (RF) energy to the end effector to treat        the tissue; applying, by the marking assembly, a distinct        marking to the tissue unique to the tissue treatment        application, wherein the distinct marking distinguishes the        tissue treatment application from other tissue treatment        applications.    -   Example 6: The method of Example 5, wherein the end effector        includes a cutting member configured to transect tissue, the        method further comprising creating the distinct marking, by the        marking assembly, adjacent a transection line defined in the        tissue by the cutting member.    -   Example 7: The method of any one of Examples 5-6, further        comprising, sensing, by the plurality of sensors, a parameter        associated with tissue positioned between first and second jaws        of the surgical instrument.    -   Example 8: The method of Example 7, further comprising,        adaptively controlling the RF energy delivered to the at least        one therapeutic electrode based on the parameter sensed by the        plurality of sensors.    -   Example 9. A method implemented by a surgical instrument        comprising a control circuit, a multi-level flexible electrode,        the multi-level flexible electrode comprises first, second, and        third insulative layers, the multi-level flexible electrode        further comprises at least one therapeutic electrode and at        least two sensing electrodes, the therapeutic electrode is        positioned between the first and second insulative layers,        wherein the therapeutic electrode is couplable to a source of        radiofrequency (RF) energy, the sensing electrode is positioned        between the second and third insulative layers, the method        comprising: contacting tissue by the at least one therapeutic        electrode and the at least two sensing electrodes; delivering RF        energy to the contacted tissue by the at least one therapeutic        electrode; sensing, by the at least two sensing electrodes, a        parameter associated with tissue positioned between first and        second jaws of the surgical instrument; and controlling, by the        control circuit, RF energy delivered to the at least one        therapeutic electrode based on the sensed parameter.    -   Example 10: The method of Example 9, further comprising sensing,        by the at least two sensing electrodes, impedance of the tissue        positioned between the first and second jaws of the surgical        instrument; electrical continuity of the tissue; or a        temperature transition point in the tissue; or a combination        thereof.    -   Example 11: The method of any one of Examples 9-10, further        comprising: applying a tissue treatment, by the at least one        therapeutic electrode, to tissue grasped between the first jaw        and the second jaw; receiving, by control circuit, sensor        signals indicative of application of the tissue treatment to the        tissue; and applying, by a marking assembly, a distinct marking        to the tissue unique to the tissue treatment application;        wherein the distinct marking distinguishes the tissue treatment        application from other tissue treatment applications.

Various additional aspects of the subject matter described herein areset out in the following numbered examples.

-   -   Example 1: A flexible electrode of a surgical instrument is        disclosed. The flexible electrode comprises a therapeutic        electrode couplable to a source of radiofrequency energy, a        sensing electrode, and an insulative layer. The insulative layer        is positioned between the therapeutic electrode and the sensing        electrode. The therapeutic electrode and the sensing electrode        are configured to contact tissue positioned between first and        second jaws of the surgical instrument.    -   Example 2: The flexible electrode of Example 1, wherein the        therapeutic electrode comprises a rectangular shape.    -   Example 3: The flexible electrode of any one of Examples 1 and        2, wherein the sensing electrode overlays the therapeutic        electrode.    -   Example 4: The flexible electrode of any one of Examples 1-3,        wherein the sensing electrode comprises a patterned shape        comprising a rectangular portion and multiple fingers extending        from the rectangular portion.    -   Example 5: The flexible electrode of any one of Examples 1-4,        wherein the sensing electrode is configured to help determine at        least one of the following: an impedance of the tissue        positioned between the first and second jaws of the surgical        instrument; an electrical continuity of the tissue; and a        temperature transition point in the tissue.    -   Example 6: The flexible electrode of any one of Examples 1, 2,        4, and 5, wherein the insulative layer overlays the therapeutic        sensing electrode.    -   Example 7: The flexible electrode of any one of Examples 1-6,        wherein the insulative layer comprises a rectangular portion and        multiple fingers extending from the rectangular portion.    -   Example 8: The flexible electrode of any one of Examples 1-7,        wherein the insulative layer is congruent with the sensing        electrode.    -   Example 9: The flexible electrode of any one of Examples 1-8,        wherein a flexibility of the insulative layer is greater than a        flexibility of the therapeutic electrode and a flexibility of        the sensing electrode.    -   Example 10: The flexible electrode of any one of Examples 1-9,        further comprising a second insulative layer, wherein the        therapeutic layer is positioned between the insulative layer and        the second instulative layer.    -   Example 11: The flexible electrode of Example 10, further        comprising a third insulative layer, wherein the sensing        electrode is positioned between the insulative layer and the        third insulative layer.    -   Example 12: A flexible electrode assembly of a surgical        instrument is disclosed. The flexible electrode assembly        comprises first and second therapeutic electrodes couplable to a        source of radiofrequency energy and first and second sensing        electrodes configured to help determine a parameter associated        with tissue positioned between first and second jaws of the        surgical instrument. The flexible electrode assembly further        comprises a first insulative layer positioned between the first        therapeutic electrode and the first sensing electrode and a        second insulative layer positioned between the second        therapeutic electrode and the second sensing electrode, wherein        the first and second therapeutic electrodes and the first and        second sensing electrodes are configured to contact the tissue.    -   Example 13: The flexible electrode assembly of Example 12,        wherein the first therapeutic electrode, the first sensing        electrode and the first insulative layer are positioned on a        first side of a knife slot of the surgical instrument, and the        second therapeutic electrode, the second sensing electrode and        the first insulative layer are positioned on an opposite side of        the knife slot.    -   Example 14: The flexible electrode assembly of any one of        Examples 12 and 13, wherein the first and second sensing        electrodes are configured to help determine at least one of the        following: an impedance of the tissue positioned between the        first and second jaws of the surgical instrument; an electrical        continuity of the tissue; and a temperature transition point in        the tissue.    -   Example 15: The flexible electrode assembly of any one of        Examples 12-14, wherein each of the first and second sensing        electrodes comprise a patterned shape comprising a rectangular        portion and multiple fingers extending from the rectangular        portion.    -   Example 16: The flexible electrode assembly of any one of        Examples 12-15, wherein each of the first and second insulative        layers comprise a patterned shape comprising a rectangular        portion and multiple fingers extending from the rectangular        portion.    -   Example 17: The flexible electrode assembly of any one of        Examples 12-16, wherein a flexibility of the first and second        insulative layers is greater than a flexibility of the first and        second therapeutic electrodes and a flexibility of the first and        second sensing electrodes.    -   Example 18: The flexible electrode assembly of any one of        Examples 12-17, wherein the first and second sensing electrodes        form a conductive gap spacer configured to control a minimum gap        between the first and second jaws.    -   Example 19: A multi-level flexible electrode of a surgical        instrument is disclosed. The multi-level flexible electrode        comprises first, second, and third insulative layers. The        multi-level flexible electrode further comprises a therapeutic        electrode and a sensing electrode. The therapeutic electrode is        positioned between the first and second insulative layers,        wherein the therapeutic electrode is couplable to a source of        radiofrequency energy. The sensing electrode is positioned        between the second and third insulative layers, wherein the        sensing electrode is configured to help determine a parameter        associated with tissue positioned between first and second jaws        of the surgical instrument, and wherein the therapeutic        electrode and the sensing electrode are configured to contact        the tissue.    -   Example 20: The multi-level electrode of Example 19, wherein the        sensing electrode is configured to help determine at least one        of the following: an impedance of the tissue positioned between        the first and second jaws of the surgical instrument; an        electrical continuity of the tissue; and a temperature        transition point in the tissue.

Various additional aspects of the subject matter described herein areset out in the following numbered examples.

-   -   Example 1: A flexible circuit of a surgical instrument is        disclosed. The flexible circuit comprises a rigid section and a        flexible section. The rigid section comprises interlocking        features for mechanical engagement with a component of the        surgical instrument. The rigid section has at least one of the        following mounted thereon: a processing device; and a logic        element. The flexible section is aligned with one of the        following: an active bending portion of a shaft assembly of the        surgical instrument; and an articulation joint of the shaft        assembly.    -   Example 2: The flexible circuit of Example 1, wherein the        flexible section is configured to bend transverse to a        longitudinal axis of the shaft assembly.    -   Example 3: The flexible circuit of any one of Example 1 and 2,        wherein the component comprises a channel retainer, and wherein        the channel retainer comprises a recess configured to receive        the rigid section.    -   Example 4: The flexible circuit of any one of Examples 1-3,        further comprising a conductive trace.    -   Example 5: The flexible circuit of Example 4, wherein a height        of the conductive trace varies along a length of the conductive        trace.    -   Example 6: The flexible circuit of any one of Examples 4 and 5,        wherein a width of the conductive trace varies along a length of        the conductive trace.    -   Example 7: The flexible circuit of any one of Examples 4-6,        wherein the conductive trace varies in height along a length of        the conductive trace and varies in width along the length of the        conductive trace.    -   Example 8: The flexible circuit of any one of Examples 4-7,        wherein a height of a first portion of the conductive trace        positioned on the flexible section is less than a height of        second portion of the conductive trace positioned on the rigid        section.    -   Example 9: The flexible circuit of any one of Examples 4-8,        wherein a width of a first portion of the conductive trace        positioned on the flexible section is less than a width of        second portion of the conductive trace positioned on the rigid        section.    -   Example 10: The flexible circuit of any one of Examples 4-9,        wherein a height of a first portion of the conductive trace        positioned on the flexible section is less than a height of a        second portion of the conductive trace positioned on the rigid        section, and a width of the first portion of the conductive        trace is greater than a width of the second portion of the        conductive trace.    -   Example 11: The flexible circuit of any one of Examples 1-10,        wherein the flexible circuit comprises a strain relief section.    -   Example 12: The flexible circuit of any one of Examples 1-11,        further comprising a conductive pad.    -   Example 13: The flexible circuit of any one of Examples 1-12,        further comprising an electromagnetic shield.    -   Example 14: A flexible circuit of a surgical instrument is        disclosed. The flexible circuit comprises a rigid section, a        flexible section, and a conductive trace positioned on both the        rigid section and the flexible section. The rigid section has at        least one of the following mounted thereon: a processing device;        and a logic element. The flexible section is aligned with one of        the following: an active bending portion of a shaft assembly of        the surgical instrument and an articulation joint of the shaft        assembly. A height and a width of the conductive trace varies        along a length of the surgical instrument.    -   Example 15: The flexible circuit of Example 14, wherein the        rigid section is configured to mechanically interlock with a        component of the surgical instrument.    -   Example 16: The flexible circuit of Example 15, wherein the        component comprises a channel retainer, and wherein the channel        retainer comprises a recess configured to receive the rigid        section.    -   Example 17: The flexible circuit of any one of Examples 14-16,        wherein the flexible section is configured to bend transverse to        a longitudinal axis of the shaft assembly.    -   Example 18: The flexible circuit of any one of Examples 14-17,        wherein a height of a first portion of the conductive trace        positioned on the flexible section is less than a height of a        second portion of the conductive trace positioned on the rigid        section, and a width of the first portion of the conductive        trace is greater than a width of the second portion of the        conductive trace.    -   Example 19: A flexible circuit of a surgical instrument is        disclosed. The flexible circuit comprises a rigid section, a        flexible section, a conductive trace, and an electromagnetic        shield. The flexible section is aligned with one of the        following: an active bending portion of a shaft assembly of the        surgical instrument; and an articulation joint of the shaft        assembly. The conductive trace is positioned on both the rigid        section and the flexible section, wherein a height and a width        of the conductive trace varies along a length of the surgical        instrument.    -   Example 20: The flexible circuit of Example 19, wherein a height        of a first portion of the conductive trace positioned on the        flexible section is less than a height of a second portion of        the conductive trace positioned on the rigid section, and a        width of the first portion of the conductive trace is greater        than a width of the second portion of the conductive trace.

Various additional aspects of the subject matter described herein areset out in the following numbered examples.

-   -   Example 1: A surgical instrument is disclosed. The surgical        instrument comprises an end effector and a marking assembly. The        end effector comprises a first jaw, a second jaw movable        relative to the first jaw to grasp tissue therebetween, and a        tissue-treatment mechanism configured to apply a tissue        treatment to tissue grasped between the first jaw and the second        jaw. The marking assembly is configured to apply a distinct        marking to the tissue unique to each tissue treatment        application. The distinct marking distinguishes the tissue        treatment application from other tissue treatment applications.    -   Example 2: The surgical instrument of Example 1, wherein the end        effector includes a cutting member configured to transect        tissue, and wherein the marking assembly is configured to create        the distinct marking adjacent a transection line defined in the        tissue by the cutting member.    -   Example 3: The surgical instrument of any one of Examples 1 and        2, wherein the distinct marking is visible only in the presence        of a light source outside of the visible spectrum.    -   Example 4: The surgical instrument of any one of Examples 1-3,        wherein the distinct marking is configured to fluoresce under an        applied light source outside of the visible spectrum.    -   Example 5: The surgical instrument of any one of Examples 1-4,        wherein the distinct marking is detectable through stimulation        by at least one of a light source, a radiation source, and an        illumination source.    -   Example 6: The surgical instrument of any one of Examples 1-5,        wherein the tissue treatment mechanism comprises a staple        cartridge configured to deploy staples into the tissue in the        tissue treatment application.    -   Example 7: The surgical instrument of any one of Examples 1-6,        wherein the tissue treatment mechanism comprises an electrode        configured to deliver therapeutic energy to the tissue in the        tissue treatment application.    -   Example 8: The surgical instrument of any one of Examples 1-7,        wherein the tissue treatment mechanism comprises a transection        member movable to transect the tissue in the tissue treatment        application.    -   Example 9: The surgical instrument of any one of Examples 1-8,        wherein application of the tissue treatment by the        tissue-treatment mechanisms triggers application of the distinct        marking to the tissue by the marking assembly.    -   Example 10: The surgical instrument of any one of Examples 1-9,        wherein the marking assembly comprises a plurality of spaced        apart applicators.    -   Example 11: The surgical instrument of Example 10, wherein the        plurality of applicators comprises a proximal applicator and a        distal applicator.    -   Example 12: The surgical instrument of any one of Examples 10        and 11, wherein the end effector comprises a longitudinal slot,        and wherein the first applicator on a first side of the        longitudinal slot and a second applicator on a second side of        the longitudinal slot opposite the first side.    -   Example 13: A surgical instrument is disclosed. The surgical        instrument comprises an end effector, a marking assembly, and a        control circuit. The end effector comprises a first jaw, a        second jaw movable relative to the first jaw to grasp tissue        therebetween, and a tissue-treatment mechanism configured to        apply a tissue treatment to tissue grasped between the first jaw        and the second jaw. The control circuit is configured to receive        sensor signals indicative of application of a tissue treatment        to the tissue and cause the marking assembly to apply a distinct        marking to the tissue unique to the tissue treatment        application, wherein the distinct marking distinguishes the        tissue treatment application from other tissue treatment        applications.    -   Example 14: The surgical instrument of Example 13, wherein the        end effector includes a cutting member configured to transect        tissue, and wherein the marking assembly is configured to create        the distinct marking adjacent a transection line defined in the        tissue by the cutting member.    -   Example 15: The surgical instrument of any one of Examples 13        and 14, wherein the distinct marking is visible only in the        presence of a light source outside of the visible spectrum.    -   Example 16: The surgical instrument of any one of Examples        13-15, wherein the distinct marking is configured to fluoresce        under an applied light source outside of the visible spectrum.    -   Example 17: The surgical instrument of any one of Examples        13-16, wherein the distinct marking is detectable through        stimulation by at least one of a light source, a radiation        source, and an illumination source.    -   Example 18: The surgical instrument of any one of Examples        13-17, wherein application of the tissue treatment by the        tissue-treatment mechanisms triggers application of the distinct        marking to the tissue by the marking assembly.    -   Example 19: The surgical instrument of any one of Examples        13-18, wherein the marking assembly comprises a plurality of        spaced apart applicators.    -   Example 20: A surgical instrument is disclosed. The surgical        instrument comprises an end effector comprising a first jaw, a        second jaw movable relative to the first jaw to grasp tissue        therebetween, and a tissue-treatment mechanism configured to        apply a tissue treatment to tissue grasped between the first jaw        and the second jaw. The surgical instrument further comprises a        means for applying a distinct marking to the tissue unique to        each tissue treatment application, wherein the distinct marking        distinguishes the tissue treatment application from other tissue        treatment applications.

Various additional aspects of the subject matter described herein areset out in the following numbered examples.

-   -   Example 1: A surgical system for use in a surgical procedure is        disclosed. The surgical system comprises a surgical hub, a        powered surgical instrument, and a communication module. The        communication module is configured to receive first data        regarding a first surgical activity of the surgical procedure,        receive second data regarding a second surgical activity of the        surgical procedure, select transmission rates for transmission        of the first data and the second data between the powered        surgical instrument and the surgical hub based on at least one        characteristic of at least one of the first surgical activity        and the second surgical activity, and transmit the first data        and the second data between the powered surgical instrument and        the surgical hub at the selected transmission rates.    -   Example 2: The surgical system of Example 1, wherein the        surgical instrument comprises an end effector transitionable        between an open configuration and a closed configuration to        grasp tissue.    -   Example 3: The surgical system of Example 2, wherein the first        data represent force to transition the end effector to the        closed configuration over time.    -   Example 4: The surgical system of any one of Examples 2 and 3,        wherein the surgical instrument comprises a translatable member        to deploy staples into the tissue grasped by the end effector.    -   Example 5: The surgical system of Example 4, wherein the second        data represent force to move the translatable member over time.    -   Example 6: The surgical system of any one of Examples 1-5,        wherein the first data and the second data are transmitted        through a communication channel established between the powered        surgical instrument and the surgical hub.    -   Example 7: The surgical system of Example 6, wherein the        communication module is further configured to adjust the        transmission rate of at least one of the first data and the        second data in response to a change in bandwidth of the        communication channel.    -   Example 8: A surgical system for use in a surgical procedure is        disclosed. The surgical system comprises a surgical hub, a        powered surgical instrument, and a communication module. The        communication module is configured to receive first data        regarding a first surgical activity of the surgical procedure,        receive second data regarding a second surgical activity of the        surgical procedure, and adjust transmission rates for        transmission of the first data and the second data between the        powered surgical instrument and the surgical hub based on at        least one characteristic of at least one of the first surgical        activity and the second surgical activity.    -   Example 9: The surgical system of Example 8, wherein the        surgical instrument comprises an end effector transitionable        between an open configuration and a closed configuration to        grasp tissue.    -   Example 10: The surgical system of Example 9, wherein the first        data represent force to transition the end effector to the        closed configuration over time.    -   Example 11: The surgical system of any one of Examples 9 and 10,        wherein the surgical instrument comprises a translatable member        movable to deploy staples into the tissue grasped by the end        effector.    -   Example 12: The surgical system of Example 11, wherein the        second data represent force to move the translatable member over        time.    -   Example 13: The surgical system of Example 12, wherein the first        data and the second data are transmitted through a communication        channel established between the powered surgical instrument and        the surgical hub.    -   Example 14: The surgical system of Example 13, wherein the        communication module is further configured to adjust the        transmission rate of at least one of the first data and the        second data in response to a change in bandwidth of the        communication channel.    -   Example 15: A surgical system for use in a surgical procedure is        disclosed. The surgical system comprises a surgical hub, a        powered surgical instrument, and a communication module. The        communication module is configured to receive first data        regarding a first surgical activity of the surgical procedure,        receive second data regarding a second surgical activity of the        surgical procedure, transmit first data and second data between        the powered surgical instrument and the surgical hub, detect an        irregularity in the second data, and adjust transmission rates        of the first data and the second data to prioritize transmission        of the irregularity in the second data.    -   Example 16: The surgical system of Example 15, wherein the        surgical instrument comprises an end effector transitionable        between an open configuration and a closed configuration to        grasp tissue.    -   Example 17: The surgical system of Example 16, wherein the first        data represent force to transition the end effector to the        closed configuration over time.    -   Example 18: The surgical system of any one of Examples 16 and        17, wherein the surgical instrument comprises a translatable        member movable to deploy staples into the tissue grasped by the        end effector.    -   Example 19: The surgical system of Example 18, wherein the        second data represent force to move the translatable member over        time.    -   Example 20: The surgical system of any one of Examples 12-19,        wherein the irregularity in the second data comprises exceeding        a predetermined threshold.

While several forms have been illustrated and described, it is not theintention of the applicant to restrict or limit the scope of theappended claims to such detail. Numerous modifications, variations,changes, substitutions, combinations, and equivalents to those forms maybe implemented and will occur to those skilled in the art withoutdeparting from the scope of the present disclosure. Moreover, thestructure of each element associated with the described forms can bealternatively described as a means for providing the function performedby the element. Also, where materials are disclosed for certaincomponents, other materials may be used. It is therefore to beunderstood that the foregoing description and the appended claims areintended to cover all such modifications, combinations, and variationsas falling within the scope of the disclosed forms. The appended claimsare intended to cover all such modifications, variations, changes,substitutions, modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually, and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as DRAM, cache, flashmemory, or other storage. Furthermore, the instructions can bedistributed via a network or by way of other computer readable media.Thus a machine-readable medium may include any mechanism for storing ortransmitting information in a form readable by a machine (e.g., acomputer), but is not limited to, floppy diskettes, optical disks,CD-ROMs, and magneto-optical disks, ROMs, RAM, EPROM, EEPROM, magneticor optical cards, flash memory, or a tangible, machine-readable storageused in the transmission of information over the Internet viaelectrical, optical, acoustical, or other forms of propagated signals(e.g., carrier waves, IR signals, digital signals, etc.). Accordingly,the non-transitory computer-readable medium includes any type oftangible machine-readable medium suitable for storing or transmittingelectronic instructions or information in a form readable by a machine(e.g., a computer).

As used throughout this description, the term “wireless” and itsderivatives may be used to describe circuits, devices, systems, methods,techniques, communications channels, etc., that may communicate datathrough the use of modulated electromagnetic radiation through anon-solid medium. The term does not imply that the associated devices donot contain any wires, although in some aspects they might not. Thecommunication module may implement any of a number of wireless or wiredcommunication standards or protocols, including but not limited to Wi-Fi(IEEE 802.11 family), WiMAX (IEEE 802.16 family), IEEE 802.20, LTE,Ev-DO, HSPA+, HSDPA+, HSUPA+, EDGE, GSM, GPRS, CDMA, TDMA, DECT,Bluetooth, Ethernet derivatives thereof, as well as any other wirelessand wired protocols that are designated as 3G, 4G, 5G, and beyond. Thecomputing module may include a plurality of communication modules. Forinstance, a first communication module may be dedicated to shorter-rangewireless communications such as Wi-Fi and Bluetooth, and a secondcommunication module may be dedicated to longer range wirelesscommunications such as GPS, EDGE, GPRS, CDMA, WiMAX, LTE, Ev-DO, andothers.

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor comprising one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, DSP, PLD, programmable logic array(PLA), or FPGA), state machine circuitry, firmware that storesinstructions executed by programmable circuitry, and any combinationthereof. The control circuit may, collectively or individually, beembodied as circuitry that forms part of a larger system, for example,an integrated circuit (IC), an application-specific integrated circuit(ASIC), a system on-chip (SoC), desktop computers, laptop computers,tablet computers, servers, smart phones, etc. Accordingly, as usedherein “control circuit” includes, but is not limited to, electricalcircuitry having at least one discrete electrical circuit, electricalcircuitry having at least one integrated circuit, electrical circuitryhaving at least one application specific integrated circuit, electricalcircuitry forming a general purpose computing device configured by acomputer program (e.g., a general purpose computer configured by acomputer program which at least partially carries out processes and/ordevices described herein, or a microprocessor configured by a computerprogram which at least partially carries out processes and/or devicesdescribed herein), electrical circuitry forming a memory device (e.g.,forms of random access memory), and/or electrical circuitry forming acommunications device (e.g., a modem, communications switch, oroptical-electrical equipment). Those having skill in the art willrecognize that the subject matter described herein may be implemented inan analog or digital fashion or some combination thereof.

As used herein a processor or processing unit is an electronic circuitwhich performs operations on some external data source, usually memoryor some other data stream. The term is used herein to refer to thecentral processor (central processing unit) in a system or computersystems (especially SoCs) that combine a number of specialized“processors.”

As used herein, an SoC or system on chip (SOC) is an IC that integratesall components of a computer or other electronic systems. It may containdigital, analog, mixed-signal, and often radio-frequency functions-allon a single substrate. A SoC integrates a microcontroller (ormicroprocessor) with advanced peripherals like graphics processing unit(GPU), Wi-Fi module, or coprocessor. A SoC may or may not containbuilt-in memory.

As used herein, a microcontroller or controller is a system thatintegrates a microprocessor with peripheral circuits and memory. Amicrocontroller (or MCU for microcontroller unit) may be implemented asa small computer on a single integrated circuit. It may be similar to aSoC; an SoC may include a microcontroller as one of its components. Amicrocontroller may contain one or more core processing units (CPUs)along with memory and programmable input/output peripherals. Programmemory in the form of Ferroelectric RAM, NOR flash or OTP ROM is alsooften included on chip, as well as a small amount of RAM.Microcontrollers may be employed for embedded applications, in contrastto the microprocessors used in personal computers or other generalpurpose applications consisting of various discrete chips.

As used herein, the term controller or microcontroller may be astand-alone IC or chip device that interfaces with a peripheral device.This may be a link between two parts of a computer or a controller on anexternal device that manages the operation of (and connection with) thatdevice.

Any of the processors or microcontrollers described herein, may beimplemented by any single core or multicore processor such as thoseknown under the trade name ARM Cortex by Texas Instruments. In oneaspect, the processor may be an LM4F230H5QR ARM Cortex-M4F ProcessorCore, available from Texas Instruments, for example, comprising on-chipmemory of 256 KB single-cycle flash memory, or other NVM, up to 40 MHz,a prefetch buffer to improve performance above 40 MHz, a 32 KBsingle-cycle SRAM, internal ROM loaded with StellarisWare® software, 2KB electrically EEPROM, one or more PWM modules, one or more QEI analog,or one or more 12-bit ADCs with 12 analog input channels, details ofwhich are available for the product datasheet.

In one aspect, the processor may comprise a safety controller comprisingtwo controller-based families such as TMS570 and RM4x known under thetrade name Hercules ARM Cortex R4, also by Texas Instruments. The safetycontroller may be configured specifically for IEC 61508 and ISO 26262safety critical applications, among others, to provide advancedintegrated safety features while delivering scalable performance,connectivity, and memory options.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware, and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets, and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions, or instruction sets and/or data that arehard-coded (e.g., non-volatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module,”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities, and/or logic states, which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolthat may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard,” published in December 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician, andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical,” “horizontal,” “up,” “down,” “left,”and “right” may be used herein with respect to the drawings. However,surgical instruments are used in many orientations and positions, andthese terms are not intended to be limiting and/or absolute.

Modular devices include the modules (as described in connection withFIGS. 3 and 9 , for example) that are receivable within a surgical huband the surgical devices or instruments that can be connected to thevarious modules in order to connect or pair with the correspondingsurgical hub. The modular devices include, for example, intelligentsurgical instruments, medical imaging devices, suction/irrigationdevices, smoke evacuators, energy generators, ventilators, insufflators,and displays. The modular devices described herein can be controlled bycontrol algorithms. The control algorithms can be executed on themodular device itself, on the surgical hub to which the particularmodular device is paired, or on both the modular device and the surgicalhub (e.g., via a distributed computing architecture). In someexemplifications, the modular devices' control algorithms control thedevices based on data sensed by the modular device itself (i.e., bysensors in, on, or connected to the modular device). This data can berelated to the patient being operated on (e.g., tissue properties orinsufflation pressure) or the modular device itself (e.g., the rate atwhich a knife is being advanced, motor current, or energy levels). Forexample, a control algorithm for a surgical stapling and cuttinginstrument can control the rate at which the instrument's motor drivesits knife through tissue according to resistance encountered by theknife as it advances.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

1. A method implemented by a surgical instrument comprising first andsecond jaws and a flexible circuit comprising multiple sensors tooptimize performance of a radio frequency (RF) device, the flexiblecircuit comprising at least one therapeutic electrode couplable to asource of RF energy, at least two sensing electrodes, and at least oneinsulative layer, the insulative layer is positioned between the atleast one therapeutic electrode and the at least two sensing electrodes,the method comprising: contacting tissue with the at least onetherapeutic electrode and at the least two sensing electrodes; sensingsignals from the at the least two sensing electrodes; and controlling RFenergy delivered to the at least one therapeutic electrode based on thesensed signals.
 2. The method of claim 1, further comprising sensing, bythe at least two sensing electrodes, impedance of the tissue positionedbetween the first and second jaws of the surgical instrument; electricalcontinuity of the tissue; or a temperature transition point in thetissue; or a combination thereof.
 3. The method of claim 1, furthercomprising, sensing, by the at least two sensing electrodes, a parameterassociated with tissue positioned between first and second jaws of thesurgical instrument.
 4. The method of claim 4, further comprising,adaptively controlling the RF energy delivered to the at least onetherapeutic electrode based on the parameter sensed by the at least twosensing electrodes.
 5. A method implemented by a surgical instrumentcomprising an end effector, a marking assembly, and a control circuit,the end effector comprising a first jaw, a second jaw movable relativeto the first jaw to grasp tissue therebetween, a plurality of sensors,and a tissue-treatment mechanism configured to apply a tissue treatmentto tissue grasped between the first jaw and the second jaw, the methodcomprising: receiving, by the control circuit, a plurality of sensorsignals from the plurality of sensors indicative of application of atissue treatment to the tissue; controlling, by the control circuit,radiofrequency (RF) energy to the end effector to treat the tissue;applying, by the marking assembly, a distinct marking to the tissueunique to the tissue treatment application, wherein the distinct markingdistinguishes the tissue treatment application from other tissuetreatment applications.
 6. The method of claim 5, wherein the endeffector includes a cutting member configured to transect tissue, themethod further comprising creating the distinct marking, by the markingassembly, adjacent a transection line defined in the tissue by thecutting member.
 7. The method of claim 5, further comprising, sensing,by the plurality of sensors, a parameter associated with tissuepositioned between first and second jaws of the surgical instrument. 8.The method of claim 7, further comprising, adaptively controlling the RFenergy delivered to the at least one therapeutic electrode based on theparameter sensed by the plurality of sensors.
 9. A method implemented bya surgical instrument comprising a control circuit, a multi-levelflexible electrode, the multi-level flexible electrode comprises first,second, and third insulative layers, the multi-level flexible electrodefurther comprises at least one therapeutic electrode and at least twosensing electrodes, the therapeutic electrode is positioned between thefirst and second insulative layers, wherein the therapeutic electrode iscouplable to a source of radiofrequency (RF) energy, the sensingelectrode is positioned between the second and third insulative layers,the method comprising: contacting tissue by the at least one therapeuticelectrode and the at least two sensing electrodes; delivering RF energyto the contacted tissue by the at least one therapeutic electrode;sensing, by the at least two sensing electrodes, a parameter associatedwith tissue positioned between first and second jaws of the surgicalinstrument; and controlling, by the control circuit, RF energy deliveredto the at least one therapeutic electrode based on the sensed parameter.10. The method of claim 9, further comprising sensing, by the at leasttwo sensing electrodes, impedance of the tissue positioned between thefirst and second jaws of the surgical instrument; electrical continuityof the tissue; or a temperature transition point in the tissue; or acombination thereof.